MEDICARE: PATSY REGINA MERRITT P.T.

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	225100000X	Physical Therapist	PTH3749	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	515-27823	OTHER	AL	BCBS - FLO REHAB
4	515-27821	OTHER	AL	BCBS - RCC REHAB
5	515-27824	OTHER	AL	BCBS - EPR REHAB

General Provider Information

NPI Number	:	1235125915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATSY REGINA MERRITT P.T.

Provider Business Mailing Address
First Line	:	1100 CIRCLE 75 PKWY SE STE 1400
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3067
Country	:	US
Telephone Number	:	678-981-3543
Fax Number	:

Provider Business Practice Location Address
First Line	:	16201 PANAMA CITY BEACH PKWY STE A
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413
Country	:	US
Telephone Number	:	850-250-0826
Fax Number	:	850-250-0840

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/05/2019

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