Provider Demographics
NPI:1386701258
Name:BLANKENSHIP, CARRI E (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CARRI
Middle Name:E
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-338-2114
Mailing Address - Fax:252-338-2115
Practice Address - Street 1:5567 N CROATAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949
Practice Address - Country:US
Practice Address - Phone:252-261-1556
Practice Address - Fax:252-261-6161
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC149CJOtherBCBS
NC7212345Medicaid
2504215Medicare PIN
NC149CJOtherBCBS