Healthcare Provider Details

I. General information

NPI: 1356518450
Provider Name (Legal Business Name): PATRICK CHARLES LEBLANC LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WATER ST
SKOWHEGAN ME
04976-1734
US

IV. Provider business mailing address

1941 HILL RD
CANAAN ME
04924-3541
US

V. Phone/Fax

Practice location:
  • Phone: 207-858-0510
  • Fax:
Mailing address:
  • Phone: 207-474-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT82
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: