=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982937900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN NEAL BLANKENSHIP PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 09/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1216 HILLCREST DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-893-7457
-----------------------------------------------------
Fax | 903-893-6671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 HILLCREST DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-893-7457
-----------------------------------------------------
Fax | 903-893-6671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2068903
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2278P1004X
-----------------------------------------------------
Taxonomy Name | Pulmonary Diagnostics Certified Respiratory Therapist
-----------------------------------------------------
License Number | 2068903
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------