Individual
JOHN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5800 OWNBY DR, DALLAS, TX 75205
(214) 768-5833
Mailing address
5118 HOMER ST, DALLAS, TX 75206-6622
(816) 517-8806
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000038921
BOC
—
01
—
AT8826
TDLR
TX
Enumeration date
07/05/2018
Last updated
01/11/2023
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