Individual
MR. JERRY D BLACKWELL JR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
2498 PINERIDGE ST, THIBODAUX, LA 70301-3959
(985) 446-7573
Mailing address
2498 PINERIDGE ST, THIBODAUX, LA 70301-3959
(985) 446-7573
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J00235
LA
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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