Healthcare Provider Details

I. General information

NPI: 1306701693
Provider Name (Legal Business Name): ZACHARY LERBLANCE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S YUKON PKWY STE 200
YUKON OK
73099-7482
US

IV. Provider business mailing address

2121 S YUKON PKWY STE 200
YUKON OK
73099-7482
US

V. Phone/Fax

Practice location:
  • Phone: 405-578-5447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6806
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: