Provider Demographics
NPI:1558336446
Name:BLALOCK, AYTREE (PT)
Entity Type:Individual
Prefix:
First Name:AYTREE
Middle Name:
Last Name:BLALOCK
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 1:200 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1842
Mailing Address - Country:US
Mailing Address - Phone:205-822-9595
Mailing Address - Fax:205-978-4964
Practice Address - Street 1:200 MONTGOMERY HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1842
Practice Address - Country:US
Practice Address - Phone:205-822-9595
Practice Address - Fax:205-978-4964
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ44124Medicare UPIN