Michael David Blackledge, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT291773 Issued in CA

Practice address

15811 Ambaum Blvd SW Ste 140
Burien, WA 98166

Phone

(206) 327-9880

NPI assigned

Dec 29, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556928000000",
    "number": "1053856070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15811 AMBAUM BLVD SW STE 140",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981663066",
            "telephone_number": "206-327-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15811 AMBAUM BLVD SW STE 140",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "98166",
            "telephone_number": "206-327-9880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15811 Ambaum Blvd SW Ste 140",
            "address_purpose": "LOCATION",
            "city": "Burien",
            "state": "WA",
            "postal_code": "98166",
            "country_code": "US",
            "telephone_number": "206-327-9880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKLEDGE",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-29",
        "last_updated": "2019-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT291773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Burien, WA
• Providers in Burien, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2019; 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.