Provider Demographics
NPI:1033507132
Name:BLAKENEY, PATTIE
Entity Type:Individual
Prefix:
First Name:PATTIE
Middle Name:
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PARKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6800
Mailing Address - Country:US
Mailing Address - Phone:432-263-0739
Mailing Address - Fax:
Practice Address - Street 1:3200 PARKWAY RD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6800
Practice Address - Country:US
Practice Address - Phone:432-263-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2027969225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant