Adam Blake

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

4965 Issued in AR

Practice address

2668 E Citizens Dr Ste 5
Fayetteville, AR 72703-4796

Phone

(479) 595-0711

NPI assigned

Sep 13, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Rise Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Fayetteville, AR
  • NPI 1851743009

  Orthopedic

  NPD

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1275203127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2668 E CITIZENS DR",
            "address_2": "STE 5",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034796",
            "telephone_number": "479-442-7473",
            "fax_number": "479-442-7473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2668 E CITIZENS DR STE 5",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034796",
            "telephone_number": "479-595-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ADAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AR",
            "license": "4965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Computer",
            "affiliation": "N",
            "address_1": "2668 E Citizens Dr Ste 5",
            "city": "Fayetteville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727034796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brett Black, MOT, OT/L
• Chaney Elizabeth Black, D.P.T.
• Hannah Black, IBCLC
• Tiffany E Black, LPC
• Laverne Ruth Blackwell, M.D.
• Jasmine N Blakney
• Julia A. Blanchard, ANP
• Anna Bland
• Courtney Denise Bland
• Scott Ryan Bland, DO

• Orthopedic Physical Therapist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Orthopedic Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; 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.