Provider Demographics
NPI:1073536231
Name:BLEDSOE, TINA M (PT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:1711 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2249
Practice Address - Country:US
Practice Address - Phone:877-240-1775
Practice Address - Fax:251-929-4741
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH2416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917620Medicaid
ALDB9027OtherRAILROAD MEDICARE GROUP
AL1003819608OtherGROUP NPI
ALK531Medicare UPIN