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General NPI Number Information
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NPI Number | 1497689673
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Entity Type | Individual
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Provider Name | KEITH LESLIE BLANKENSHIP PT
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Gender | Male
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 3040 RIVERSIDE DR STE C5
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City | MACON
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State | GA
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Zip | 31210-0406
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Country | US
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Telephone | 478-475-9393
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Fax | 478-475-9353
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Provider Business Mailing Address
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Address Line | 137 OLD RIDGE RD
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City | MACON
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State | GA
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Zip | 31211-6330
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Country | US
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Telephone | 478-361-9689
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Fax | 478-475-9353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT001629
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License Number State | GA
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