Provider Demographics
NPI:1053336768
Name:BLAND, DERON J (PT)
Entity type:Individual
Prefix:MR
First Name:DERON
Middle Name:J
Last Name:BLAND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:126 E ELLENDALE ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8917
Mailing Address - Country:US
Mailing Address - Phone:985-876-9555
Mailing Address - Fax:985-876-0180
Practice Address - Street 1:1322 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3961
Practice Address - Country:US
Practice Address - Phone:985-876-9555
Practice Address - Fax:985-876-0180
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA00677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist