Healthcare Provider Details

I. General information

NPI: 1184781866
Provider Name (Legal Business Name): ALLISON BROOKE BLATT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 OXFORD CRES NE
ATLANTA GA
30319-1624
US

IV. Provider business mailing address

1966 MASON MILL RD
DECATUR GA
30033-4067
US

V. Phone/Fax

Practice location:
  • Phone: 404-247-7959
  • Fax: 404-459-6566
Mailing address:
  • Phone: 404-247-7959
  • Fax: 404-459-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number008798
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: