MEDICARE: MRS. BRITTANY LANELL BLOUGH M.S.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT870308	DC
2	225100000X	Physical Therapist	2305209117	VA

General Provider Information

NPI Number	:	1336182559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITTANY LANELL BLOUGH M.S.P.T.

Provider Business Mailing Address
First Line	:	3767 FETTLER PARK DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22025-1946
Country	:	US
Telephone Number	:	703-730-6400
Fax Number	:	703-730-9212

Provider Business Practice Location Address
First Line	:	3767 FETTLER PARK DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22025-1946
Country	:	US
Telephone Number	:	703-730-6400
Fax Number	:	703-730-9212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/23/2015

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