Brentley Kyle Blackmon, PTA
Physical Therapy Assistant in Waco, TX. Individual provider (NPI-1).
NPI number1114409588
StatusActive
Last updated in NPPESSep 3, 2018
Details
- NPI
- 1114409588
- Entity type
- Individual (NPI-1)
- Name
- Brentley Kyle Blackmon
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 3, 2018
- Last updated
- Sep 3, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 2108097 | TX | Yes |
Practice location
401 Owen LnWaco, TX 76710-5599
Phone 254-772-8900
Mailing address
401 Owen LnWaco, TX 76710-5599
Phone 254-772-8900
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Physical Therapy Assistant providers in Waco, TX
- Alexandria Alexander, PTANPI 1528545811
- Louis AnciraNPI 1093976565
- Monica Anderson, PTANPI 1619457454
- Leslie Ann Andrews, PTANPI 1053894956
- Ashley Benitez, PTANPI 1720570567
- Rochelle B BreemesNPI 1720568488
- Lisa BrinkNPI 1407249683
- Eva Annette Callicoatte, PTANPI 1063126621
- Diana Cuevas CooperNPI 1861973208
- Tara Dean Croford, PTANPI 1679054068
All 46 Physical Therapy Assistant providers in Waco · All 4,231 providers in Waco
Checking a whole list?
Paste a list of NPIs and get status, record, Medicare enrollment and OIG exclusion for each one. 10 free a day, then credits from $29 for 5,000. Useful for credentialing, billing and pharmacy claim checks.