Provider Demographics
NPI:1780891242
Name:ALAN R TRAMMELL & JAMES C BLYTHE
Entity type:Organization
Organization Name:ALAN R TRAMMELL & JAMES C BLYTHE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:940-665-3496
Mailing Address - Street 1:1020 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-3524
Mailing Address - Country:US
Mailing Address - Phone:940-665-3496
Mailing Address - Fax:
Practice Address - Street 1:1020 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3524
Practice Address - Country:US
Practice Address - Phone:940-665-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00017SMedicare PIN