Individual
BLAKELYNN COLCLASURE BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4616 HIGHWAY 84 W, VIDALIA, LA 71373-3357
(318) 336-5400
(318) 336-8622
Mailing address
4616 HIGHWAY 84 W, VIDALIA, LA 71373-3357
(318) 336-5400
(318) 336-8622
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10613
LA
261QP2000X
Physical Therapy Clinic/Center
10613
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2532499
—
LA
Enumeration date
06/15/2020
Last updated
01/31/2024
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