Active NPI
Spencer David Blackie, PT, DPT, MA, OTR,
- Physical Therapist
- Prescott, WI
National Provider Identifier
1083982565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4300-24
- Practice address
- 1505 Orrin Rd
Prescott, WI 54021-1074 - Phone
- (715) 262-1107
- NPI assigned
- Dec 12, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4300-24 | WI | Primary |
| Occupational Therapist | 225X00000X | 1811-26 | WI |
Addresses
Primary practice location
1505 Orrin Rd
Prescott, WI 54021-1074
Mailing address
1505 Orrin Rd
Prescott, WI 54021-1074
Phone (715) 262-1107
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4300-24 | WI | MD | Physical Therapist |
| 1811-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1083982565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 ORRIN RD",
"city": "PRESCOTT",
"state": "WI",
"postal_code": "540211074",
"telephone_number": "715-262-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 ORRIN RD",
"city": "PRESCOTT",
"state": "WI",
"postal_code": "540211074",
"telephone_number": "715-262-1107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKIE",
"first_name": "SPENCER",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PT, DPT, MA, OTR,",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-12",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "4300-24",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "1811-26",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, WI
Sources for this page
- 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.