Healthcare Provider Details

I. General information

NPI: 1982937900
Provider Name (Legal Business Name): SHAWN NEAL BLANKENSHIP PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 HILLCREST DR
SHERMAN TX
75092-5507
US

IV. Provider business mailing address

1216 HILLCREST DR
SHERMAN TX
75092
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7457
  • Fax: 903-893-6671
Mailing address:
  • Phone: 903-893-7457
  • Fax: 903-893-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2068903
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number2068903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: