Provider Demographics
NPI:1497154645
Name:LEBLANC, SOPHIA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:JEIWEI
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1219 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2347
Mailing Address - Country:US
Mailing Address - Phone:225-658-7751
Mailing Address - Fax:225-658-7753
Practice Address - Street 1:1219 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2347
Practice Address - Country:US
Practice Address - Phone:225-658-7751
Practice Address - Fax:225-658-7753
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist