Basic Information
| Provider Information | |||||||||
| NPI: | 1336675362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANKENSHIP | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 FARSON ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141066 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2660 KULL RD | ||||||||
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| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431307707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403040285 | ||||||||
| FaxNumber: | 7402772546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.