Healthcare Provider Details

I. General information

NPI: 1851008064
Provider Name (Legal Business Name): CALLIE MARIE BLACHOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 NW 10TH PL
GAINESVILLE FL
32605-4213
US

IV. Provider business mailing address

662 SE COUNTY ROAD 241
LULU FL
32061-7583
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3111
  • Fax:
Mailing address:
  • Phone: 386-867-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number22776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: