Individual
MARTHA ANN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
313 POPLAR ST, LOOGOOTEE, IN 47553-2423
(812) 295-4433
Mailing address
13272 PINE TREE RD, LOOGOOTEE, IN 47553-4746
(812) 295-5302
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002054A
IN
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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