Provider Demographics
NPI:1245348804
Name:SUBLETT, PATRICIA KAY (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
Last Name:SUBLETT
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 1:807 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9495
Mailing Address - Country:US
Mailing Address - Phone:850-763-0505
Mailing Address - Fax:850-763-0966
Practice Address - Street 1:807 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-9495
Practice Address - Country:US
Practice Address - Phone:850-763-0505
Practice Address - Fax:850-763-0966
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1787225100000X
FLFL 6666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33920OtherBLUE CROSS BLUE SHIELD
AL527086Medicaid
AL000033920Medicaid
AL000033920Medicare ID - Type Unspecified
AL527086Medicaid