Active NPI
Stephanie Danielle Blake, DPT
- Geriatric Physical Therapist
- Andover, KS
National Provider Identifier
1003124769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 11-04112
- Practice address
- 621 W 21St St
Andover, KS 67002-8498 - Phone
- (316) 733-1349
- NPI assigned
- Sep 15, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 11-04112 | KS | Primary |
Addresses
Primary practice location
621 W 21St St
Andover, KS 67002-8498
Mailing address
4141 Danbury St
Bel Aire, KS 67220-1933
Phone (316) 744-2773
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-04112 | KS | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284508800000",
"number": "1003124769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4141 DANBURY ST",
"city": "BEL AIRE",
"state": "KS",
"postal_code": "672201933",
"telephone_number": "316-744-2773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 W 21ST ST",
"city": "ANDOVER",
"state": "KS",
"postal_code": "670028498",
"telephone_number": "316-733-1349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "STEPHANIE",
"middle_name": "DANIELLE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-15",
"last_updated": "2010-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "KS",
"license": "11-04112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.