Provider Demographics
NPI:1336182559
Name:BLOUGH, BRITTANY LANELL (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LANELL
Last Name:BLOUGH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3767 FETTLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1946
Mailing Address - Country:US
Mailing Address - Phone:703-730-6400
Mailing Address - Fax:703-730-9212
Practice Address - Street 1:3767 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1946
Practice Address - Country:US
Practice Address - Phone:703-730-6400
Practice Address - Fax:703-730-9212
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870308225100000X
VA2305209117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist