Individual
BEVERLY BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-7182
(770) 719-7189
Mailing address
12320 EDGEWATER DR, HAMPTON, GA 30228-2645
(770) 478-5131
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT000628
GA
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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