Provider Demographics
NPI:1427293828
Name:LEBLANC, ADRIENNE LYNNE (PT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LYNNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LYNNE
Other - Last Name:SCHUESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1930 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7518
Mailing Address - Country:US
Mailing Address - Phone:480-456-0719
Mailing Address - Fax:480-456-0163
Practice Address - Street 1:1930 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-456-0719
Practice Address - Fax:480-456-0163
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456112Medicaid