Provider Demographics
NPI:1255186524
Name:TRI CORE BLASTING
Entity type:Organization
Organization Name:TRI CORE BLASTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-505-9509
Mailing Address - Street 1:13209 FM 2796
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-8224
Mailing Address - Country:US
Mailing Address - Phone:903-505-9509
Mailing Address - Fax:
Practice Address - Street 1:13209 FM 2796
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-8224
Practice Address - Country:US
Practice Address - Phone:903-505-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI CORE BLASTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy