Provider Demographics
NPI:1083435077
Name:BLANKENSHIP, CRYSTAL DAWN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SHERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206-1500
Mailing Address - Country:US
Mailing Address - Phone:304-689-0585
Mailing Address - Fax:
Practice Address - Street 1:121 SHERWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:COWEN
Practice Address - State:WV
Practice Address - Zip Code:26206-1500
Practice Address - Country:US
Practice Address - Phone:304-689-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002174225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant