Provider Demographics
NPI:1376954230
Name:BLAIKIE, JEAN GUNTER (PT)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:GUNTER
Last Name:BLAIKIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4509
Mailing Address - Country:US
Mailing Address - Phone:803-980-4900
Mailing Address - Fax:803-980-4902
Practice Address - Street 1:129 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4509
Practice Address - Country:US
Practice Address - Phone:803-980-4900
Practice Address - Fax:803-980-4902
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010969225100000X
SC886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty