Provider Demographics
NPI:1356493290
Name:BLACKWELL, BARBARA J (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ASHKINS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660
Mailing Address - Country:US
Mailing Address - Phone:774-268-1813
Mailing Address - Fax:
Practice Address - Street 1:38 ROUTE 134
Practice Address - Street 2:SUITE 7A
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3700
Practice Address - Country:US
Practice Address - Phone:774-268-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205172251X0800X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No133N00000XDietary & Nutritional Service ProvidersNutritionist