Individual
KEN BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
480 GALLETTI WAY, SPARKS, NV 89431-5564
(775) 333-0943
Mailing address
7491 AMBUSH CT, SPARKS, NV 89436-7459
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
NV
Enumeration date
09/26/2010
Last updated
09/26/2010
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