Provider Demographics
NPI:1932392545
Name:SEARCY, BLAINE
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:
Last Name:SEARCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BLAINE
Other - Middle Name:
Other - Last Name:SEARCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:713 SEAGULL CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1943
Mailing Address - Country:US
Mailing Address - Phone:850-837-2002
Mailing Address - Fax:850-837-8230
Practice Address - Street 1:713 SEAGULL CIR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-1943
Practice Address - Country:US
Practice Address - Phone:850-837-2002
Practice Address - Fax:850-837-8230
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0003891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0003891OtherMASSAGE THERAPIST