Provider Demographics
NPI:1740463892
Name:BLACKWOOD, ELIZABETH (MPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:3787 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6148
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-251-0421
Practice Address - Street 1:3100 DURALEIGH RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8105
Practice Address - Country:US
Practice Address - Phone:919-788-8797
Practice Address - Fax:919-313-1276
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC8370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00638598OtherRR MEDICARE
Q38634AMedicare PIN