Active NPI
Kerrie Blades, DPT
- Physical Therapist
- Moreno Valley, CA
National Provider Identifier
1174954648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40746
- Practice address
- 14900 Pete Dye St
Moreno Valley, CA 92555-6333 - Phone
- (951) 315-5307
- NPI assigned
- Dec 9, 2013
- Last updated
- Dec 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40746 | CA | Primary |
Addresses
Primary practice location
14900 Pete Dye St
Moreno Valley, CA 92555-6333
Mailing address
14900 Pete Dye St
Moreno Valley, CA 92555-6333
Phone (951) 315-5307
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40746 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386547200000",
"number": "1174954648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14900 PETE DYE ST",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925556333",
"telephone_number": "951-315-5307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14900 PETE DYE ST",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925556333",
"telephone_number": "951-315-5307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLADES",
"first_name": "KERRIE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-09",
"last_updated": "2013-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "40746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.