# TRAIL BLAZIN THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336367135
- **Authorized official:** MRS. RACHELLE BENTON P.T. (OWNER,MANAGER)
- **Authorized official phone:** (601) 845-0876

## Contact information

- **Practice address:** 260 BARNES RD, FLORENCE, MS 39073-8066
- **Practice address phone:** (601) 845-0876
- **Mailing address:** 260 BARNES RD, FLORENCE, MS 39073-8066
- **Mailing address phone:** (601) 845-0876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | P.T.0978 | MS | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09016256 | — | MS |