Provider Demographics
NPI:1447322524
Name:BLACKBURN, JOSEPH EUGENE (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-0134
Mailing Address - Country:US
Mailing Address - Phone:731-298-1430
Mailing Address - Fax:
Practice Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5314
Practice Address - Country:US
Practice Address - Phone:850-215-7093
Practice Address - Fax:850-215-7096
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6912225100000X
FL27320225100000X
HI3203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1841247418OtherGROUP NPI
TN1841247418OtherGROUP NPI