Provider Demographics
NPI:1851059869
Name:BLANCAVER, LESYL LEMON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LESYL
Middle Name:LEMON
Last Name:BLANCAVER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7314 ASPIRE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1183
Mailing Address - Country:US
Mailing Address - Phone:702-409-7828
Mailing Address - Fax:
Practice Address - Street 1:4445 S GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7127
Practice Address - Country:US
Practice Address - Phone:702-920-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist