Provider Demographics
NPI:1083870711
Name:BLEVINS, VERONICA (PT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S COUNTY ROAD 525 W
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8077
Mailing Address - Country:US
Mailing Address - Phone:317-628-1403
Mailing Address - Fax:
Practice Address - Street 1:360 S COUNTY ROAD 525 W
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-8077
Practice Address - Country:US
Practice Address - Phone:317-628-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010424225100000X
TX1185820225100000X
IN05012377A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist