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General NPI Number Information
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NPI Number | 1326703646
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Entity Type | Individual
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Provider Name | RYAN BLACKBURN
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Gender | Male
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 411 W NORTH ST
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City | POPLARVILLE
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State | MS
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Zip | 39470-2203
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Country | US
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Telephone | 601-795-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 42465 HIGHWAY 195
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City | HALEYVILLE
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State | AL
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Zip | 35565-7052
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Country | US
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Telephone | 256-350-1764
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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 | 7955
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License Number State | MS
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