Individual
ROBERT C BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
211 W 38TH ST, SCOTTSBLUFF, NE 69361-4626
(308) 633-2025
Mailing address
3035 EAGLE POINTE, GERING, NE 69341-1574
(308) 631-4637
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
187
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025780200
—
NE
Enumeration date
08/18/2009
Last updated
11/04/2009
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