Individual
SARAH ELISE BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
206 OLD CORINTH RD, PETAL, MS 39465-2932
(601) 583-9464
(601) 583-9465
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 583-9464
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05538733
—
MS
Enumeration date
06/13/2014
Last updated
07/20/2020
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