Stan E. Blackburn, MS, PT

Primary specialty

SpecialistTaxonomy code 174400000X

License

1027654 Issued in TX

Practice address

4003 Calloway Dr
Mansfield, TX 76063-3448

Phone

(817) 727-3182

Fax

(682) 518-5603

NPI assigned

May 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boyznberry Corporation

  • Contractor
  • Mansfield, TX
  • NPI 1447469986
  NPD (past) Authorized official
• Health Care Express Corporation

  dba Health Care Express

  • Geriatric Physical Therapist
  • Dallas, TX
  • NPI 1518972926
  NPD (past) Authorized official

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780893230",
    "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": {
        "last_name": "BLACKBURN",
        "first_name": "STAN",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "MS, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "1027654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST",
            "identifier": "1027654",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sapan Bindal, M.D.
• Cade Bingham, PTA
• Caroline Bosibori Birai
• BJSS LLC (Cardinal Hospice)
• Harold Lee Black, DC
• Brenna Daunelle Blackwell, FNP
• David Blackwell, DDS
• Clayton Clark Blakeney, M.S., CCC/A
• Alan L Blankenship Jr., MD
• Ashley Blankenship

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.