Provider Demographics
NPI:1629173042
Name:BLANKENSHIP, CARMEN (PT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BLANKENSHIP
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 1:15328 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2640
Mailing Address - Country:US
Mailing Address - Phone:253-863-0404
Mailing Address - Fax:253-863-5834
Practice Address - Street 1:15328 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2640
Practice Address - Country:US
Practice Address - Phone:253-863-0404
Practice Address - Fax:253-863-5834
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT2607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA51171OtherLABOR & INDUSTRIES
WA8346421Medicaid