Provider Demographics
NPI:1396014015
Name:BLOUGH, DONALD HARLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:HARLEY
Last Name:BLOUGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 AMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6918
Mailing Address - Country:US
Mailing Address - Phone:770-627-2968
Mailing Address - Fax:
Practice Address - Street 1:4921 AMBERTON DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6918
Practice Address - Country:US
Practice Address - Phone:770-627-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist