Provider Demographics
NPI:1659580884
Name:MURPHY, BLAKE (PTA)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-8045
Mailing Address - Country:US
Mailing Address - Phone:731-221-8273
Mailing Address - Fax:
Practice Address - Street 1:1855 HIGHWAY 51 BY-PASS NORTH SUITE A
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-287-0069
Practice Address - Fax:731-287-9888
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant