Individual
STACI M BLYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1202 SHILOH SQ, EVANSVILLE, IN 47714-0860
(812) 890-5983
Mailing address
1202 SHILOH SQUARE, EVANSVILLE, IN 47714
(812) 890-5983
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
09/09/2011
Last updated
09/09/2011
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