Individual
ERIC BLACKSTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12544 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5259
(703) 730-6969
Mailing address
12544 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5259
(703) 730-6969
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305210784
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305210784
LICENSE NUMBER
VA
Enumeration date
11/14/2016
Last updated
11/14/2016
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