Provider Demographics
NPI:1295261071
Name:3JKENTERPRISES
Entity type:Organization
Organization Name:3JKENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:325-200-8641
Mailing Address - Street 1:919 EARLY BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2209
Mailing Address - Country:US
Mailing Address - Phone:325-646-9900
Mailing Address - Fax:325-646-9100
Practice Address - Street 1:919 EARLY BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2209
Practice Address - Country:US
Practice Address - Phone:325-646-9900
Practice Address - Fax:325-646-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1120111261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy