Provider Demographics
NPI:1962980409
Name:BLACKBURN, LEXIS ANN LEARMONTH (DPT)
Entity type:Individual
Prefix:
First Name:LEXIS
Middle Name:ANN LEARMONTH
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEXIS
Other - Middle Name:A
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4299
Mailing Address - Country:US
Mailing Address - Phone:918-927-3199
Mailing Address - Fax:918-927-3201
Practice Address - Street 1:2488 E 81ST ST STE 290
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4299
Practice Address - Country:US
Practice Address - Phone:918-927-3199
Practice Address - Fax:918-927-3201
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4482225100000X
OK6610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist