| Doctor Name: | DR. HEATHER MCCOY BLACKISTON |
| NPI Number: | 1619926623 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DC |
| License Number: | 02079 |
| Business Practice Address: | 4925 Pulaski Hwy Ste B Perryville, MD - 219031605 |
| Business Phone Number: | 4106429110 |
| Business Fax Number: | 4106429113 |
| Mailing Address: | 4925 Pulaski Hwy Ste B, PERRYVILLE |
| State: | MD |
| Postal Code: | 219031605 |
| Phone Number: | 4106429110 |
| Fax Number: | 4106429113 |
| NPI Enumeration Date: | 05/08/2006 |
| NPI Last Update Date: | 07/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 02079 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |