Provider Demographics
NPI:1235125915
Name:MERRITT, PATSY REGINA (PT)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:REGINA
Last Name:MERRITT
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 1:1100 CIRCLE 75 PKWY SE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3067
Mailing Address - Country:US
Mailing Address - Phone:678-981-3543
Mailing Address - Fax:
Practice Address - Street 1:16201 PANAMA CITY BEACH PKWY STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413
Practice Address - Country:US
Practice Address - Phone:850-250-0826
Practice Address - Fax:850-250-0840
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890013410Medicaid
AL890013740Medicaid
AL515-27823OtherBCBS - FLO REHAB
AL515-27821OtherBCBS - RCC REHAB
AL515-27824OtherBCBS - EPR REHAB
AL515-27824OtherBCBS - EPR REHAB
AL515-27821OtherBCBS - RCC REHAB