Gina Lynette Blackerby, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1065332 Issued in TX

Practice address

620 W Bank St
Iowa Park, TX 76367-2830

Phone

(940) 592-5900

Fax

(940) 592-5969

NPI assigned

Jun 17, 2005

Sex

Female

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 TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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 and National Provider Directory roles.

• Iowa Park Physical Therapy

  • Physical Therapist
  • Iowa Park, TX
  • NPI 1164609186
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1689679466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 BRIDWELL RD",
            "city": "IOWA PARK",
            "state": "TX",
            "postal_code": "763678104",
            "telephone_number": "940-855-8019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W BANK ST",
            "city": "IOWA PARK",
            "state": "TX",
            "postal_code": "763672830",
            "telephone_number": "940-592-5900",
            "fax_number": "940-592-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKERBY",
        "first_name": "GINA",
        "middle_name": "LYNETTE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1065332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Back by Design, PLLC
• Rita Mae Bales, MASSAGE THERAPIST
• Stephanie M Beard, LPC
• Linda Michelle Beavers, LVN
• Daniel Don Beutel, CSFA
• Booker Hospital District
• Kristie Renee Boswell
• Kimberlee A Bradshaw, MS, LPC
• Breazi Britt
• James P Doherty, DO

• Physical Therapist in Iowa Park, TX
• Providers in Iowa Park, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; 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.