Gina Renee Blake, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7434 Issued in GA

Practice address

4754 Martin Rd
Suite 200
Flowery Branch, GA 30542-3507

Phone

(770) 967-4377

Fax

(770) 967-8077

NPI assigned

Jan 3, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lanier Therapy in Motion

  • Physical Therapist
  • Gainesville, GA
  • NPI 1568400968
  NPD (past)

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1053596569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "GINA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-03",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "7434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11816396",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "20265I4817",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Anne Belangee, FNP-BC
• Steven Benjamin, MS, RD, CSSD, CSCS
• Salman Bhatti, OD
• Staci Sandler Blackmore, PHARMD
• Brendon Blake, P.T.
• Eric L Bohn, M.D.
• Trevor Bond, DPT
• Booker Oral Surgery & Implant Center PC
• Reginald Douglas Booker, D.D.S.
• Karon Bradley

• Physical Therapist in Flowery Branch, GA
• Providers in Flowery Branch, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.