Individual
BLAKE JORDAN FALCONELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
6542 GOODMAN RD STE 101, OLIVE BRANCH, MS 38654-5559
(662) 874-5964
(662) 874-5176
Mailing address
6542 GOODMAN RD STE 101, OLIVE BRANCH, MS 38654-5559
(662) 874-5964
(662) 874-5176
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13705
TN
Other
Enumeration date
08/24/2021
Last updated
02/01/2023
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