Provider Demographics
NPI:1699450445
Name:BLITHE, SEAN FRANKLIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:FRANKLIN
Last Name:BLITHE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SURREY PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2536
Mailing Address - Country:US
Mailing Address - Phone:770-714-6239
Mailing Address - Fax:
Practice Address - Street 1:125 GRAND OAK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4632
Practice Address - Country:US
Practice Address - Phone:770-692-9446
Practice Address - Fax:770-626-5341
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist