Provider Demographics
NPI:1578788089
Name:BECKHAM, CINDY BLISSETT (PT)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:BLISSETT
Last Name:BECKHAM
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 1:1910 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5579
Mailing Address - Country:US
Mailing Address - Phone:912-537-3055
Mailing Address - Fax:912-277-2099
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8845
Practice Address - Country:US
Practice Address - Phone:912-277-2044
Practice Address - Fax:912-277-2099
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics