Provider Demographics
NPI:1104255827
Name:LEBLANC, CHRISTINE THOMPSON (LMT, PTA, CA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:THOMPSON
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LMT, PTA, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WILLAMETTE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4093
Mailing Address - Country:US
Mailing Address - Phone:541-484-5777
Mailing Address - Fax:541-284-2704
Practice Address - Street 1:1524 WILLAMETTE ST STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4093
Practice Address - Country:US
Practice Address - Phone:541-484-5777
Practice Address - Fax:541-284-2704
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist