Individual
NICHOLAS BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1 STILL HOPES DR, WEST COLUMBIA, SC 29169-7164
(803) 233-7130
Mailing address
1 STILL HOPES DR, WEST COLUMBIA, SC 29169-7164
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1955
SC
Other
Enumeration date
04/08/2014
Last updated
04/08/2014
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