Healthcare Provider Details

I. General information

NPI: 1316946205
Provider Name (Legal Business Name): RACHEL ROSS BLACKWOOD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HIGHWAY 87 SUITE 100
CALERA AL
35040
US

IV. Provider business mailing address

PO BOX 1694
CALERA AL
35040-1694
US

V. Phone/Fax

Practice location:
  • Phone: 205-621-3077
  • Fax: 205-621-3788
Mailing address:
  • Phone: 205-621-3077
  • Fax: 205-621-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTH4114
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: