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General NPI Number Information
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NPI Number | 1417209719
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Entity Type | Individual
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Provider Name | SALLY J BLUNIER L.P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BLVD
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City | FORT BENNING
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State | GA
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Zip | 31905-2102
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Country | US
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Telephone | 762-408-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 482 LEE ROAD 554
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City | PHENIX CITY
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State | AL
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Zip | 36867-0939
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Country | US
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Telephone | 386-405-8329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA19110
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License Number State | FL
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