Individual provider · Type 1 NPI

Brentley Kyle Blackmon, PTA

Physical Therapy Assistant · Waco, TX

NPI number 1114409588 Active

Practice location

401 Owen Ln
Waco, TX 76710-5599

Specialties and licenses

Taxonomy	Code	License
Physical Therapy Assistant Primary	225200000X	2108097 (TX)

Physical Therapy Assistant: (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of …

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About NPI 1114409588

Brentley Kyle Blackmon, PTA's National Provider Identifier is 1114409588, issued on Sep 3, 2018. The primary taxonomy on file is Physical Therapy Assistant (225200000X), and the practice location is in Waco, TX. The record was last updated on Sep 3, 2018.