Provider Demographics
NPI:1437355633
Name:LE BLANC, ERIN E (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:LE BLANC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 EMBARCADERO DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4087
Mailing Address - Country:US
Mailing Address - Phone:916-933-1221
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:4242 SPORTS CLUB DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-9546
Practice Address - Country:US
Practice Address - Phone:530-677-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23032OtherPT LICENSE#