Provider Demographics
NPI:1588911093
Name:BLANKENSHIP, BRIAN KEITH (PTA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GOSHENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8837
Mailing Address - Country:US
Mailing Address - Phone:615-974-2642
Mailing Address - Fax:
Practice Address - Street 1:813 S DICKERSON RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1761
Practice Address - Country:US
Practice Address - Phone:615-859-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5307225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant