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General NPI Number Information
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NPI Number | 1063300382
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Entity Type | Individual
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Provider Name | ALEX DONALD BLACKBURN
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Gender | Male
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 863 HATHAWAY RD
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1916
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Country | US
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Telephone | 508-996-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 345 NATICK CT
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City | WEXFORD
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State | PA
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Zip | 15090-9574
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Country | US
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Telephone | 412-660-5680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL88854
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License Number State | MA
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