Blake Jordan Falconello, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13705 Issued in TN

Practice address

6542 Goodman Rd Ste 101
Olive Branch, MS 38654-5559

Phone

(662) 874-5964

Fax

(662) 874-5176

NPI assigned

Aug 24, 2021

Last updated

Feb 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Huling Physical Therapy LLCGroup PAC ID 0547633943, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Huling Physical Therapy LLC

  • Physical Therapist
  • Olive Branch, MS
  • NPI 1700598349
  Medicare reassignment Care Compare group NPD
• MSK Group PC

  dba OrthoSouth

  • Orthopaedic Surgery Physician
  • Southaven, MS
  • NPI 1912303447

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1104593599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6542 GOODMAN RD STE 101",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386545559",
            "telephone_number": "662-874-5964",
            "fax_number": "662-874-5176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6542 GOODMAN RD STE 101",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386545559",
            "telephone_number": "662-874-5964",
            "fax_number": "662-874-5176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALCONELLO",
        "first_name": "BLAKE",
        "middle_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Care Surgery Center of Olive Branch,LLC
• Eyedok LLC
• Fab Enterprises LLC
• Fairuza Zan Trust
• Faith of a Mustard Seed Psychiatric Wellness, PLLC
• Feel Good Health & Wellness LLC
• Amanda Ferguson, SLP
• Demetrice Fields-Knight
• Silver Astria Fields, LPN
• Finding Your Truth Counseling Services

• Physical Therapist in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.