Provider Demographics
NPI:1164853412
Name:BLACKWELL, WREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WREN
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ATLEE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1815
Mailing Address - Country:US
Mailing Address - Phone:804-569-1787
Mailing Address - Fax:804-569-1787
Practice Address - Street 1:3001 HUNGARY SPRING RD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2428
Practice Address - Country:US
Practice Address - Phone:804-756-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist