Provider Demographics
NPI:1619862265
Name:BLACKLINE RECOVERY
Entity type:Organization
Organization Name:BLACKLINE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDYE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:918-729-5396
Mailing Address - Street 1:11693 N GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-5417
Mailing Address - Country:US
Mailing Address - Phone:918-729-5396
Mailing Address - Fax:
Practice Address - Street 1:11693 N GARNETT RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-5417
Practice Address - Country:US
Practice Address - Phone:918-729-5396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy