Provider Demographics
NPI:1689759995
Name:BLACKBURN, JOANNA M (MPT, CLT,DSCPT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MPT, CLT,DSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 HIGH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1152
Mailing Address - Country:US
Mailing Address - Phone:410-778-6565
Mailing Address - Fax:410-778-6536
Practice Address - Street 1:818 HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1152
Practice Address - Country:US
Practice Address - Phone:410-778-6565
Practice Address - Fax:410-778-6536
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405154800Medicaid
MD405154800Medicaid