Provider Demographics
NPI:1770628919
Name:BLANKENSHIP, LESLIE C (LPTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-1903
Mailing Address - Country:US
Mailing Address - Phone:870-857-0049
Mailing Address - Fax:870-857-3027
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-1903
Practice Address - Country:US
Practice Address - Phone:870-857-0049
Practice Address - Fax:870-857-3027
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA959225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant