Individual
LANEY REVAE BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 N 14TH ST, PARAGOULD, AR 72450
(870) 476-9017
(870) 362-2018
Mailing address
2903 STONEGATE DRIVE, PARAGOULD, AR 72450
(870) 450-1413
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4834
AR
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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