Blackwell, Connie J
Blackwell, Connie J is an individual health care provider with primary practice located at 5219 88Th Ave , Kenosha WI 53144-7468. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Blackwell, Connie J can be contacted via phone (262) 653-0850.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant | 225200000X | 1326-019 | Wisconsin |
Profile Details
| NPI number | 1699823542 |
|---|---|
| LBN Legal business name | Blackwell, Connie J |
| Credentials | Physical Therapist Assistant (PTA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 8th, 2007 |
| Last updated | Apr 8th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699823542 | NPPES |
| Wisconsin | MEDICAID | 36122800 |
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