Provider Demographics
NPI:1629854724
Name:BLITCH, TATUM VICTORIA (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:TATUM
Middle Name:VICTORIA
Last Name:BLITCH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SHASTA CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9237
Mailing Address - Country:US
Mailing Address - Phone:912-682-1592
Mailing Address - Fax:
Practice Address - Street 1:1207 SHASTA CT
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-9237
Practice Address - Country:US
Practice Address - Phone:912-682-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist