Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1356357354 |
---|---|
Provider Name | Mr. Mark Christopher Blackwell |
First Address | Spring Branch, TX 78070-6156 |
Second Address | Kerrville, TX 78028-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |