Charles Blake, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

420820 Issued in TN

Practice address

Moncrief Army Health Clinic
4500 8TH Division Drive
Columbia, SC 29207

Phone

(803) 751-7183

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1104892637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MONCRIEF ARMY HEALTH CLINIC",
            "address_2": "4500 8TH DIVISION DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29207",
            "telephone_number": "803-751-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MONCRIEF ARMY HEALTH CLINIC",
            "address_2": "4500 8TH DIVISION DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29207",
            "telephone_number": "803-751-7183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Blanchfield Army Community Hospital",
            "address_2": "650 Joel Drive",
            "address_purpose": "LOCATION",
            "city": "Fort Campbell",
            "state": "KY",
            "postal_code": "422235349",
            "country_code": "US",
            "telephone_number": "270-798-8372",
            "fax_number": "270-956-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TN",
            "license": "420820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Blackwell
• Edgar Andrew Blackwell III, PHARMD
• Daniel P Blair, DPT
• Donna K Blair, CRNA
• Suzanne Blais
• Elizabeth W. Blake, PHARMD
• James Blake Jr., RPH
• James Austin Blakely
• Hayden Blakeney, RBT
• Allysen Taylor Blaker

• All providers in Columbia, SC
• Orthopedic Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.