Provider Demographics
NPI:1699142703
Name:BLEVINS, DENNIS RAY JR (DPT)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
Last Name:BLEVINS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DIXIE LEE CENTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIMBALL
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5672
Mailing Address - Country:US
Mailing Address - Phone:423-837-7536
Mailing Address - Fax:423-837-7538
Practice Address - Street 1:400 DIXIE LEE CENTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5672
Practice Address - Country:US
Practice Address - Phone:423-837-7536
Practice Address - Fax:423-837-7538
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist