Provider Demographics
NPI:1851539720
Name:BLACKSHER, ADRIENNE T (PT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:T
Last Name:BLACKSHER
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 1:2410 DEKALB MEDICAL PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4999
Mailing Address - Country:US
Mailing Address - Phone:678-418-8072
Mailing Address - Fax:678-518-0137
Practice Address - Street 1:2410 DEKALB MEDICAL PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4999
Practice Address - Country:US
Practice Address - Phone:678-418-8072
Practice Address - Fax:678-518-0137
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist