Provider Demographics
NPI:1518986769
Name:BLACKMAN, PATRICIA WIENS (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:WIENS
Last Name:BLACKMAN
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 1:2121 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2849
Mailing Address - Country:US
Mailing Address - Phone:518-274-0230
Mailing Address - Fax:518-274-0276
Practice Address - Street 1:2121 6TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2849
Practice Address - Country:US
Practice Address - Phone:518-274-0230
Practice Address - Fax:518-274-0276
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004187-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01332301Medicaid
NYDD4597Medicare ID - Type Unspecified