Individual provider Active NPI

Blake Litton Fletcher, DPT

  • Physical Therapist
  • Irmo, SC
National Provider Identifier
1205273620
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6960 Issued in SC
Practice address
10071 Broad River Rd Ste B
Irmo, SC 29063-2381
Phone
(803) 445-1069
Fax
(803) 445-1097
NPI assigned
May 24, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6960 SC Primary

Addresses

Primary practice location

10071 Broad River Rd Ste B
Irmo, SC 29063-2381

Mailing address

141 Atrium Way
Columbia, SC 29223-6301

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131125000474 SC Practitioner - Physical Therapist in Private Practice 4880820760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10071 Broad River Rd
Suite B
Irmo, SC 29063-2381
Phone (803) 445-1069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Physical Therapy and Sports Medicine Limited Partnership Physical Therapist CurrentSince Jul 1, 2017 Accepting new patients

Locations

141 Atrium Way
Columbia, SC 29223
Phone (803) 788-8484

10071 Broad River Rd
Ste B
Irmo, SC 29063
Phone (803) 445-1069

863 Coleman Blvd
Ste B
Mt Pleasant, SC 29464
Phone (843) 881-8887

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1205273620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 ATRIUM WAY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10071 BROAD RIVER RD STE B",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632381",
            "telephone_number": "803-445-1069",
            "fax_number": "803-445-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "BLAKE",
        "middle_name": "LITTON",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-24",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "6960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irmo, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.