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Individual

MR. STAN E. BLACKBURN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS, PT

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
174400000X
Specialist
Primary
1027654
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1027654
PHYSICAL THERAPIST
TX
Enumeration date
05/22/2007
Last updated
07/08/2007
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