Provider Demographics
NPI:1285186601
Name:BLEVINS, RORY
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BUSINESS CENTER DR
Mailing Address - Street 2:6112
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 BUSINESS CENTER DR
Practice Address - Street 2:6112
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2482
Practice Address - Country:US
Practice Address - Phone:281-627-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer