Provider Demographics
NPI:1295046050
Name:BLACKETER ENTERPRISES, INC
Entity Type:Organization
Organization Name:BLACKETER ENTERPRISES, INC
Other - Org Name:THERAPY EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLACKETER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-483-1746
Mailing Address - Street 1:6033 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1042
Mailing Address - Country:US
Mailing Address - Phone:817-483-1746
Mailing Address - Fax:817-483-5874
Practice Address - Street 1:6033 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1042
Practice Address - Country:US
Practice Address - Phone:817-483-1746
Practice Address - Fax:817-483-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-27
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107195Medicare PIN