Provider Demographics
NPI:1356518450
Name:LEBLANC, PATRICK CHARLES (LMT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHARLES
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:ME
Mailing Address - Zip Code:04924-3541
Mailing Address - Country:US
Mailing Address - Phone:207-474-3081
Mailing Address - Fax:
Practice Address - Street 1:312 WATER ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1734
Practice Address - Country:US
Practice Address - Phone:207-858-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT82225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist