Provider Demographics
NPI:1982937900
Name:BLANKENSHIP, SHAWN NEAL (PTA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:NEAL
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-893-7457
Mailing Address - Fax:903-893-6671
Practice Address - Street 1:1216 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5507
Practice Address - Country:US
Practice Address - Phone:903-893-7457
Practice Address - Fax:903-893-6671
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068903225200000X, 2278P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2068903OtherPTA LICENCE