Provider Demographics
NPI:1053193110
Name:BLANKENSHIP, CHAD (PT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MOUNT SAINT HELENS CT
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6731
Mailing Address - Country:US
Mailing Address - Phone:509-727-8283
Mailing Address - Fax:
Practice Address - Street 1:8819 W VICTORIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7193
Practice Address - Country:US
Practice Address - Phone:509-783-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist