Provider Demographics
NPI:1649450073
Name:BASLOT, JOEL N (PT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:N
Last Name:BASLOT
Suffix:
Gender:M
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:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29602-1864
Mailing Address - Country:US
Mailing Address - Phone:864-331-0919
Mailing Address - Fax:864-331-0922
Practice Address - Street 1:2307 E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6351
Practice Address - Country:US
Practice Address - Phone:843-423-4888
Practice Address - Fax:803-548-5023
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2883OtherSTATE OF SC LICENSE
SC2883OtherSTATE OF SC LICENSE