Active NPI
Nathan Blake, PT
- Physical Therapist
- East Longmeadow, MA
National Provider Identifier
1306293147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 22298
- Practice address
- 168 Denslow Rd
East Longmeadow, MA 01028-3188 - Phone
- (413) 526-9924
- Fax
- (413) 526-9961
- NPI assigned
- May 23, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 22298 | MA | Primary |
Addresses
Primary practice location
168 Denslow Rd
East Longmeadow, MA 01028-3188
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22298 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1306293147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "168 DENSLOW RD",
"city": "EAST LONGMEADOW",
"state": "MA",
"postal_code": "010283188",
"telephone_number": "413-526-9924",
"fax_number": "413-526-9961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "NATHAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-23",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "22298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.