Provider Demographics
NPI:1215119839
Name:HILL COUNTRY UPPER EXTREMITY THERAPY, PLLC
Entity type:Organization
Organization Name:HILL COUNTRY UPPER EXTREMITY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED UPPER EXTREMITY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LOT/ CHT
Authorized Official - Phone:512-301-2403
Mailing Address - Street 1:11208 TRACTON LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1595
Mailing Address - Country:US
Mailing Address - Phone:512-301-2403
Mailing Address - Fax:512-301-2899
Practice Address - Street 1:1701 N HWY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4311
Practice Address - Country:US
Practice Address - Phone:512-301-2403
Practice Address - Fax:512-301-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2771Medicare UPIN