Basic Information
| Provider Information | |||||||||
| NPI: | 1235125915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRITT | ||||||||
| FirstName: | PATSY | ||||||||
| MiddleName: | REGINA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 CIRCLE 75 PKWY SE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789813543 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16201 PANAMA CITY BEACH PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502500826 | ||||||||
| FaxNumber: | 8502500840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH3749 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 890013410 | 05 | AL | MEDICAID | 890013740 | 05 | AL | MEDICAID | 515-27823 | 01 | AL | BCBS - FLO REHAB | OTHER | 515-27821 | 01 | AL | BCBS - RCC REHAB | OTHER | 515-27824 | 01 | AL | BCBS - EPR REHAB | OTHER |