Provider Demographics
NPI:1588805022
Name:LEBLANC, JOANNE L (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEAHY DR
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-9726
Mailing Address - Country:US
Mailing Address - Phone:360-678-4890
Mailing Address - Fax:
Practice Address - Street 1:11042 SR 525
Practice Address - Street 2:STE 106
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8618
Practice Address - Country:US
Practice Address - Phone:360-331-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60043383225200000X
CAAT 6206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant