Individual
MR. JOHN DONALD BLACKBURN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1995 THUNDER RD, EAGLE LAKE, FL 33839-3086
(863) 224-4085
Mailing address
367 HOLLY RIDGE RD, WINTER HAVEN, FL 33880-1114
(863) 224-4085
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
5880
FL
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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