MEDICARE: LONNIE BLAKE DORCEY RPT

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	208100000X	Physical Medicine & Rehabilitation Physician	PT3848	AL

General Provider Information

NPI Number	:	1033165113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNIE BLAKE DORCEY RPT

Provider Business Mailing Address
First Line	:	1201 3RD AVE N STE B
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	205-566-1674
Fax Number	:	205-278-6900

Provider Business Practice Location Address
First Line	:	1201 3RD AVE N STE B
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	256-546-8127
Fax Number	:	256-547-6720

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/29/2018

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