MEDICARE: ANDREW JAMES BLACKBURN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1407414	TX

General Provider Information

NPI Number	:	1376422428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JAMES BLACKBURN PT

Provider Business Mailing Address
First Line	:	12114 NOEL ESPINOZA CIR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7177
Country	:	US
Telephone Number	:	915-490-0663
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 TRAWOOD DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3115
Country	:	US
Telephone Number	:	915-223-6349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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