MEDICARE: GARRETT BLANTON

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	225200000X	Physical Therapy Assistant	2-0942	AL

General Provider Information

NPI Number	:	1598237935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT BLANTON

Provider Business Mailing Address
First Line	:	1391 E HIGHLAND AVE STE 103
Second Line	:
City	:	SELMA
State	:	AL
Zip	:	36703-3204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1391 E HIGHLAND AVE STE 103
Second Line	:
City	:	SELMA
State	:	AL
Zip	:	36703-3204
Country	:	US
Telephone Number	:	334-875-6110
Fax Number	:

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

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	12/26/2018

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Directions to “ GARRETT BLANTON ” Practice Location

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