Bevan D Blake, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

344859-2401 Issued in UT

Practice address

370 E South Temple
#250
Salt Lake City, UT 84111-1206

Phone

(801) 512-2656

Fax

(801) 906-0336

NPI assigned

Aug 3, 2005

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

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Utah School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

In Motion Physical Therapy LLCGroup PAC ID 0345498424, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• In Motion Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Draper, UT
  • NPI 1538422324
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1114928868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 E SOUTH TEMPLE",
            "address_2": "#250",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111206",
            "telephone_number": "801-512-2656",
            "fax_number": "801-906-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 E SOUTH TEMPLE",
            "address_2": "#250",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111206",
            "telephone_number": "801-512-2656",
            "fax_number": "801-906-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "BEVAN",
        "middle_name": "D",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "344859-2401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "64-00731",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "68963",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870388269BR1",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ9402",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "34485924000001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "5417",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Felisha Kiyomi Blair
• Gary Dean Blair
• Jaycee Blair, PHARMD
• Sarah Elizabeth Blair, CSW
• Andrew Blake, CCC-SLP
• David Blake
• Jennifer Sara Blake, PHARMD
• Kate Blake, NP
• Kelly Blake, MS, RDN
• Thomas William Blake

• Physical Therapist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.