Keith Allen Blake, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

6125 Issued in TN

Practice address

1 Veterans Way
Knoxville, TN 37931-3161

Phone

(865) 862-8100

NPI assigned

Jan 25, 2019

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": "1548374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1235693110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 BUFFALO RD",
            "city": "ONEIDA",
            "state": "TN",
            "postal_code": "378417403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS WAY",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379313161",
            "telephone_number": "865-862-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-25",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "6125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malcolm Blair, PA-C
• Gregory Harold Blake, MD, MPH
• Jeneve Samantha Blake
• John R Blake Jr., M.D.
• Kaela Elise Parnell Blake, M.D.
• Michael Blake, B.S.
• Michael C. Blake, M.D.
• Patricia Gabrielle Blake, LCSW
• Patrick Grayson Blake, DPT
• Stephanie Kay Blake, DPT

• Physical Therapy Assistant in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; 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.