Provider Demographics
NPI:1205169224
Name:LEBLANC, JUDITH H (LMT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:H
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3625
Mailing Address - Country:US
Mailing Address - Phone:337-280-5074
Mailing Address - Fax:337-896-1982
Practice Address - Street 1:309 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3625
Practice Address - Country:US
Practice Address - Phone:337-280-5074
Practice Address - Fax:337-896-1982
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA3153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist