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1417077116
BEVERLY BLAKELY
FAYETTEVILLE, GA
NPI
1417077116
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: GA PT000628)
Enumeration Date
2007-03-29
Last Update Date
2007-07-08
Business Address
-- BEVERLY BLAKELY PT
1255 HIGHWAY 54 W
FAYETTEVILLE, GA 30214-4526
Phone number: 770-719-7182
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Mailing Address
-- BEVERLY BLAKELY PT
12320 EDGEWATER DR
HAMPTON, GA 30228-2645
Phone number: 770-478-5131
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