John D. Blackburn, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

102571 Issued in MO

Practice address

500 Porter Ave
Aurora, MO 65605-2365

Phone

(417) 678-7887

Fax

(417) 678-7876

NPI assigned

Jan 8, 2008

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 8, 2008.

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1891970901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PORTER AVE",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656052365",
            "telephone_number": "417-678-7887",
            "fax_number": "417-678-7876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PORTER AVE",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656052365",
            "telephone_number": "417-678-7887",
            "fax_number": "417-678-7876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "JOHN",
        "middle_name": "D.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "102571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Aurora, MO
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; 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.