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NPI Code Detail

MEDICARE: MS. DAWANNA D BLUE PT

MEDICARE: MS. DAWANNA D BLUE PT
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
1225100000XPhysical TherapistPT3957MS

General Provider Information

NPI Number : 1760451280
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAWANNA D BLUE PT
Provider Business Mailing Address
First Line : 129 AIRPARK DRIVE
Second Line :
City : PHILADELPHIA
State : MS
Zip : 39350
Country : US
Telephone Number : 601-656-2525
Fax Number : 601-774-5125
Provider Business Practice Location Address
First Line : 25117 HIGHWAY 15
Second Line :
City : UNION
State : MS
Zip : 39365-9088
Country : US
Telephone Number : 601-774-1588
Fax Number : 601-774-5125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 06/04/2010

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Directions to “ MS. DAWANNA D BLUE PT” Practice Location

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