Provider Demographics
NPI:1710966833
Name:LEBLANC, PATRICIA MARIE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:20055 SW PACIFIC HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9294
Practice Address - Country:US
Practice Address - Phone:503-625-1691
Practice Address - Fax:503-926-1460
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR2684225100000X
MAQA0515100225100000X
CT003918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278081Medicaid
OR278081Medicaid