MEDICARE: STEPHANIE BLOUNT

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	0004409	FL

General Provider Information

NPI Number	:	1518364249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BLOUNT

Provider Business Mailing Address
First Line	:	3667 WINDING LAKE CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3667 WINDING LAKE CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2659
Country	:	US
Telephone Number	:	850-431-1155
Fax Number	:	850-431-6555

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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Directions to “ STEPHANIE BLOUNT ” Practice Location

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