Blaylock Rehabilitation, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT009057 Issued in GA

Legal business name

BLAYLOCK REHABILITATION, LLC

Practice address

7248 Parkland BND
Fairburn, GA 30213-5435

Phone

(470) 241-4010

NPI assigned

Apr 7, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Akilah S. Blaylock, DPT

Title

Owner/Physical Therapist

Phone

(470) 241-4010

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523059200000",
    "number": "1013414937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 982",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302130982",
            "telephone_number": "470-241-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7248 PARKLAND BND",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302135435",
            "telephone_number": "470-241-4010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAYLOCK REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-07",
        "last_updated": "2018-04-07",
        "status": "A",
        "authorized_official_last_name": "BLAYLOCK",
        "authorized_official_first_name": "AKILAH",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "470-241-4010",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT009057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.