Provider Demographics
NPI:1508432782
Name:BLAYLOCK, ALICIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3353
Mailing Address - Country:US
Mailing Address - Phone:405-573-0121
Mailing Address - Fax:405-573-0124
Practice Address - Street 1:1250 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3353
Practice Address - Country:US
Practice Address - Phone:405-573-0121
Practice Address - Fax:405-573-0124
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist