Individual
MR. SAMUEL E BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
735 SW 11TH ST, STE 103, REDMOND, OR 97756-2649
(541) 923-1436
(541) 923-1467
Mailing address
735 SW 11TH ST, STE 103, REDMOND, OR 97756-2649
(541) 923-1436
(541) 923-1467
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0908
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-4082000
BLUE CROSS BLUE SHIELD
OR
05
—
233502
—
OR
Enumeration date
02/12/2007
Last updated
08/18/2008
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