Active NPI
Kristen Blazek, PT, DPT
- Physical Therapist
- White Rock, SC
National Provider Identifier
1316459886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8189
- Practice address
- 2101 Dutch Fork Rd
White Rock, SC 29177 - Phone
- (803) 732-8790
- NPI assigned
- Oct 24, 2017
- 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 | 8189 | SC | Primary |
Addresses
Primary practice location
2101 Dutch Fork Rd
White Rock, SC 29177
Mailing address
PO Box 444
White Rock, SC 29177-0444
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 |
|---|---|---|---|
| 8189 | SC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1316459886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 444",
"city": "WHITE ROCK",
"state": "SC",
"postal_code": "291770444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 DUTCH FORK RD",
"city": "WHITE ROCK",
"state": "SC",
"postal_code": "29177",
"telephone_number": "803-732-8790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAZEK",
"first_name": "KRISTEN",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-24",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "8189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Rock, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.