Provider Demographics
NPI:1548469349
Name:BLENKLE, LISA RENEE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:BLENKLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:WARHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4929 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0664
Mailing Address - Country:US
Mailing Address - Phone:480-590-6921
Mailing Address - Fax:
Practice Address - Street 1:4929 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0664
Practice Address - Country:US
Practice Address - Phone:480-590-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 253622251G0304X
AZLPT-315022251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics