Provider Demographics
NPI:1992987424
Name:LEBLANC, NICOLE (PT)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500409
Mailing Address - Street 2:1 LOWER NAVY HILL ROAD COMMONWEATH HEALTH CENTER PHYSIC
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-236-8327
Mailing Address - Fax:670-234-8930
Practice Address - Street 1:1 LOWER NAVY HILL ROAD
Practice Address - Street 2:COMMONWEATH HEALTH CENTER PHYSICAL THERAPY DEPT
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-236-8327
Practice Address - Fax:670-234-8930
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP22225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist