Organization Active NPI

Rogue Physio LLC

  • Physical Therapist
  • Oak Ridge, TN
National Provider Identifier
1104704824
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ROGUE PHYSIO LLC
Practice address
564 Oak Ridge Tpke
Oak Ridge, TN 37830-7164
Phone
(865) 213-2744
Fax
(865) 315-7033
NPI assigned
Aug 21, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Authorized official

Name
Michael David Blair, PT DPTNPI 1518687052
Title
Owner/ Physical Therapist
Phone
(865) 363-1222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

564 Oak Ridge Tpke
Oak Ridge, TN 37830-7164

Mailing address

564 Oak Ridge Tpke
Oak Ridge, TN 37830-7164
Phone (865) 213-2744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260205001101 TN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8729567243 Receives reassigned benefits from 2 practitioners
Practice locations: Oak Ridge, TN

National Provider Directory

National Provider Directory

Locations

562 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 250-4569

564 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 213-2744

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1755734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1104704824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 OAK RIDGE TPKE",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378307164",
            "telephone_number": "865-213-2744",
            "fax_number": "865-315-7033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 OAK RIDGE TPKE",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378307164",
            "telephone_number": "865-213-2744",
            "fax_number": "865-315-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE PHYSIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-21",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/ PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "865-363-1222",
        "authorized_official_credential": "PT DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Ridge, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.