Provider Demographics
NPI:1407958812
Name:LEBLANC, RYAN (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2B LEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351
Mailing Address - Country:US
Mailing Address - Phone:860-376-2564
Mailing Address - Fax:860-376-4812
Practice Address - Street 1:2B LEE RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3042
Practice Address - Country:US
Practice Address - Phone:860-376-2564
Practice Address - Fax:860-376-4812
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist