Provider Demographics
NPI:1306539929
Name:BLANKENSHIP, TAYLER (LMT)
Entity type:Individual
Prefix:
First Name:TAYLER
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16130 S HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-9559
Mailing Address - Country:US
Mailing Address - Phone:479-879-8016
Mailing Address - Fax:
Practice Address - Street 1:16130 S HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-9559
Practice Address - Country:US
Practice Address - Phone:479-879-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist