Provider Demographics
NPI:1952962839
Name:BLACKWELL, ERIN VICK (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:VICK
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 E GLENN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6448
Mailing Address - Country:US
Mailing Address - Phone:334-821-2256
Mailing Address - Fax:334-826-8082
Practice Address - Street 1:2515 E GLENN AVE STE 104
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6448
Practice Address - Country:US
Practice Address - Phone:334-821-2256
Practice Address - Fax:334-826-8082
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist