Organization
BOYZNBERRY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STAN E BLACKBURN MS,PT (PRESIDENT)
(817) 727-3182
Entity
Organization
Contact information
Practice address
4003 CALLOWAY DR, MANSFIELD, TX 76063-3448
(817) 727-3182
(682) 518-5603
Mailing address
4003 CALLOWAY DR, MANSFIELD, TX 76063-3448
(817) 727-3182
(682) 518-5603
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1027654
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1027654
PHYSICAL THERAPIST
TX
Enumeration date
05/22/2007
Last updated
08/22/2020
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