Provider Demographics
NPI:1043015753
Name:JENA BLACKWOOD PT DPT PLLC
Entity type:Organization
Organization Name:JENA BLACKWOOD PT DPT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:917-565-9812
Mailing Address - Street 1:32 UNION SQ E STE 1217
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3225
Mailing Address - Country:US
Mailing Address - Phone:917-565-9812
Mailing Address - Fax:844-990-4145
Practice Address - Street 1:32 UNION SQ E STE 1217
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3225
Practice Address - Country:US
Practice Address - Phone:917-565-9812
Practice Address - Fax:844-990-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty