Provider Demographics
NPI:1174205314
Name:BLANKENSHIP, SETH DANIEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:DANIEL
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 RIVERY BLVD APT 4210
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3039
Mailing Address - Country:US
Mailing Address - Phone:832-866-3073
Mailing Address - Fax:
Practice Address - Street 1:2217 PARK BEND DR STE 240
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5674
Practice Address - Country:US
Practice Address - Phone:832-866-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13790602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic