Provider Demographics
NPI:1578521332
Name:BLANKSTEEN, SHELLEY (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BLANKSTEEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:CASCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2740 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6141
Mailing Address - Country:US
Mailing Address - Phone:501-329-5459
Mailing Address - Fax:501-327-1738
Practice Address - Street 1:1900 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6620
Practice Address - Country:US
Practice Address - Phone:501-821-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2635225100000X
ARPT26352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y368OtherABCBS