Provider Demographics
NPI:1790914885
Name:BLAKELY, BEVERLY HYATT (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:HYATT
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14312 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-7330
Mailing Address - Country:US
Mailing Address - Phone:256-232-4808
Mailing Address - Fax:
Practice Address - Street 1:1600 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2333
Practice Address - Country:US
Practice Address - Phone:256-232-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist