Organization
TRAIL BLAZIN THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RACHELLE BENTON P.T. (OWNER,MANAGER)
(601) 845-0876
Entity
Organization
Contact information
Practice address
260 BARNES RD, FLORENCE, MS 39073-8066
(601) 845-0876
Mailing address
260 BARNES RD, FLORENCE, MS 39073-8066
(601) 845-0876
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P.T.0978
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016256
—
MS
Enumeration date
04/24/2007
Last updated
08/22/2020
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