Blake Dircksen DPT PT PLLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

BLAKE DIRCKSEN DPT PT PLLC

Doing business as

Backroads Endurance Company

Practice address

348 S 6TH St
Noblesville, IN 46060-2519

Phone

(317) 385-8525

NPI assigned

Nov 15, 2023

Last updated

Nov 15, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

BLAKE DIRCKSEN DPT PT PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Blake Dircksen, DPTNPI 1073023735

Title

Owner

Phone

(317) 385-8525

Specialties & licenses 1

Addresses

Other names 1

• Backroads Endurance Company Doing business as

Part of

Blake Dircksen DPT PT PLLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Blake Arnold Dircksen, DPT, CSCS

  • Orthopedic Physical Therapist
  • New York, NY
  • NPI 1073023735
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1053186536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 S 6TH ST",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460602519",
            "telephone_number": "317-385-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 S 6TH ST",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460602519",
            "telephone_number": "317-385-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE DIRCKSEN DPT PT PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLAKE DIRCKSEN DPT PT PLLC",
        "enumeration_date": "2023-11-15",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "DIRCKSEN",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-385-8525",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Backroads Endurance Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthopedic Physical Therapist in Noblesville, IN
• Providers in Noblesville, IN by specialty
• Orthopedic Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.