Individual
MARK WILLIAM BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
PHYSICAL THERAPY CLINIC, USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913-4604
(719) 526-7120
Mailing address
1650 COCHRANE CIR, ATTN: CREDENTIALS OFFICE, USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913-4604
(719) 526-7844
(719) 526-7984
Taxonomy
Speciality
Code
Description
License number
State
2251E1300X
Clinical Electrophysiology Physical Therapist
Primary
2788
CO
Other
Enumeration date
05/12/2006
Last updated
07/02/2025
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