Provider Demographics
NPI:1578523940
Name:MORELLI, CEBRINA BLAKEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CEBRINA
Middle Name:BLAKEY
Last Name:MORELLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 IDAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7568
Mailing Address - Country:US
Mailing Address - Phone:901-829-6473
Mailing Address - Fax:
Practice Address - Street 1:8253 US HIGHWAY 51 N
Practice Address - Street 2:SUITE 102
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1727
Practice Address - Country:US
Practice Address - Phone:901-872-6422
Practice Address - Fax:901-872-6497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00446628Medicaid
TN446628Medicare ID - Type Unspecified