Boyznberry Corporation

Primary specialty

ContractorTaxonomy code 171W00000X

License

1027654 Issued in TX

Legal business name

BOYZNBERRY CORPORATION

Practice address

4003 Calloway Dr
Mansfield, TX 76063-3448

Phone

(817) 727-3182

Fax

(682) 518-5603

NPI assigned

May 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stan E Blackburn, MS,PTNPI 1780893230

Title

President

Phone

(817) 727-3182

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stan E. Blackburn, MS, PT

  • Specialist
  • Mansfield, TX
  • NPI 1780893230
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447469986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4003 CALLOWAY DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633448",
            "telephone_number": "817-727-3182",
            "fax_number": "682-518-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 CALLOWAY DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633448",
            "telephone_number": "817-727-3182",
            "fax_number": "682-518-5603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYZNBERRY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "STAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-727-3182",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS,PT"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": "TX",
            "license": "1027654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamera Bounds, LPTA
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• Tyler Boyd, PTA
• Bradford Chiropractic PLLC
• Kirk Henry Bradford, D.C.
• Hallie Bradley, MD
• Brady Medical Group PLLC
• Ronald Wayne Brady, LCSW

• Contractor in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.