Provider Demographics
NPI:1629492731
Name:BLACKLOCK, SABRA
Entity Type:Individual
Prefix:
First Name:SABRA
Middle Name:
Last Name:BLACKLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3852
Mailing Address - Country:US
Mailing Address - Phone:303-506-8117
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3852
Practice Address - Country:US
Practice Address - Phone:303-506-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist