Provider Demographics
NPI:1366001174
Name:LEBLANC, MOLLY (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5819 HEFNER VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7757
Mailing Address - Country:US
Mailing Address - Phone:775-857-7907
Mailing Address - Fax:
Practice Address - Street 1:7401 RIVERSIDE PKWY UNIT 219
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5057
Practice Address - Country:US
Practice Address - Phone:918-216-9303
Practice Address - Fax:539-202-5007
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist