Provider Demographics
NPI:1184792954
Name:SCHEXNAILDER, ROBERTA BLACKBURN (PT)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:BLACKBURN
Last Name:SCHEXNAILDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:MARIE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:624 LAFAYETTE ST STE C
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5410
Practice Address - Country:US
Practice Address - Phone:337-451-5947
Practice Address - Fax:337-451-6219
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431320Medicaid
LAPT00676OtherPHYSICAL THERAPY LICENSE
LA5X710Medicare ID - Type Unspecified