Basic Information
| Provider Information | |||||||||
| NPI: | 1609526425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANKENSHIP | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | FAYE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25887 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731250887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182591888 | ||||||||
| FaxNumber: | 9182513725 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 DAISY DR # F-3 | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744647410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184589235 | ||||||||
| FaxNumber: | 9184589236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2022 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5959 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.