Individual
JODY BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.T.
Contact information
Practice address
4305 S HULEN ST, FORT WORTH, TX 76109-4917
(682) 225-6090
Mailing address
4305 S HULEN ST, FORT WORTH, TX 76109-4917
(682) 225-6090
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT038617
TX
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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