Provider Demographics
NPI:1356357354
Name:BLACKWELL, MARK CHRISTOPHER (KT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:KT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STIRRUP DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6156
Mailing Address - Country:US
Mailing Address - Phone:830-438-7894
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-896-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist