Kevin Russell Blackmon, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18620 Issued in FL

Practice address

8391 N Davis Hwy
Pensacola, FL 32514-6048

Phone

(850) 494-5403

Fax

(850) 494-4910

NPI assigned

Aug 5, 2006

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)

Enrolled

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 and National Provider Directory roles.

• West Florida Healthworks LLC

  • Specialist
  • Pensacola, FL
  • NPI 1891742326

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1801805254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8391 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325146048",
            "telephone_number": "850-494-5403",
            "fax_number": "850-494-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8391 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325146048",
            "telephone_number": "850-494-5403",
            "fax_number": "850-494-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "KEVIN",
        "middle_name": "RUSSELL",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT18620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LICENSE",
            "identifier": "PT18620",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Chisum Blackburn, PH.D., A.R.N.P.
• Audrey Rae Blackburn
• Kaitlin Elizabeth Blackburn, DDS
• Marc Blackburn, D.D.S.
• Donald L Blackmon Jr., MD
• Stacia Blackmon
• Matthew Lewis Blair, D.O.
• Ashley Harris Blake, LPN
• McKenzie Blake
• Jared Christian Blakely

• Physical Therapist in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.