Healthcare Provider Details

I. General information

NPI: 1578523940
Provider Name (Legal Business Name): CEBRINA BLAKEY MORELLI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8253 US HIGHWAY 51 N SUITE 102
MILLINGTON TN
38053-1727
US

IV. Provider business mailing address

10020 IDAVILLE RD
ATOKA TN
38004-7568
US

V. Phone/Fax

Practice location:
  • Phone: 901-872-6422
  • Fax: 901-872-6497
Mailing address:
  • Phone: 901-829-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3263
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: