Provider Demographics
NPI:1376580217
Name:BLAKE, JOYANNA HOPE (PT)
Entity Type:Individual
Prefix:
First Name:JOYANNA
Middle Name:HOPE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOYANNA
Other - Middle Name:HOPE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-802-1991
Mailing Address - Fax:706-802-1408
Practice Address - Street 1:502 GI MADDOX PKWY
Practice Address - Street 2:UNIT E
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-3222
Practice Address - Country:US
Practice Address - Phone:706-695-9699
Practice Address - Fax:706-695-1623
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT04006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist