JERRY D BLACKWELL JR

THIBODAUX, LA
NPI1598473860
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: LA  J00235)
Enumeration Date2022-11-07
Last Update Date2022-11-07
Business Address
Mr. JERRY D BLACKWELL JR LAT
2498 PINERIDGE ST
THIBODAUX, LA 70301-3959
Phone number: 985-446-7573
Mailing Address
Mr. JERRY D BLACKWELL JR LAT
2498 PINERIDGE ST
THIBODAUX, LA 70301-3959
Phone number: 985-446-7573
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