Provider Demographics
NPI:1205394277
Name:BLANCHARD, SHAWN BROOK (DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:BROOK
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:3267 BEE CAVES RD STE 126
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6774
Practice Address - Country:US
Practice Address - Phone:512-202-8634
Practice Address - Fax:512-961-8907
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019007769225100000X
TX1349610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist