Provider Demographics
NPI:1013350784
Name:BLACKBURN CONSULTING, LLC
Entity Type:Organization
Organization Name:BLACKBURN CONSULTING, LLC
Other - Org Name:BLACKBURN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GAWEN
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:603-277-9784
Mailing Address - Street 1:45 LYME RD
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1219
Mailing Address - Country:US
Mailing Address - Phone:603-277-9784
Mailing Address - Fax:443-926-5980
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 206A
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:603-277-9784
Practice Address - Fax:443-926-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700901261OtherINDIVIDUAL NPI