Individual
MR. DOUGLAS OLIVER BLACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MHA, LAT, CMPE
Contact information
Practice address
3618 GARRETTSVILLE DR, PEARLAND, TX 77584-4984
(281) 412-2769
Mailing address
3618 GARRETTSVILLE DR, PEARLAND, TX 77584-4984
(281) 412-2769
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129039099
NATA CERTIFICATION
—
Enumeration date
03/06/2007
Last updated
12/15/2019
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