Blake Graham

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6164 Issued in OK

Practice address

16502 N Pennsylvania Ave Ste C
Edmond, OK 73012-9126

Phone

(405) 285-9659

NPI assigned

Jun 12, 2022

Last updated

Jun 12, 2022By the provider in NPPES

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

Enrolled in OK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Function Physical Therapy, LLCGroup PAC ID 8325364151, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Function Physical Therapy, LLC

  • Physical Therapist
  • Edmond, OK
  • NPI 1538564224
  Medicare reassignment Care Compare group
• Function Physical Therapy South LLC

  • Physical Medicine & Rehabilitation Physician
  • Village, OK
  • NPI 1043005572
  Medicare reassignment NPD

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

{
    "created_epoch": "1654992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654992000000",
    "number": "1376273557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16502 N PENNSYLVANIA AVE STE C",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730129126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16502 N PENNSYLVANIA AVE STE C",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730129126",
            "telephone_number": "405-285-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-12",
        "last_updated": "2022-06-12",
        "certification_date": "2022-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "6164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert D Gourley, MD
• Aaron Michael Gowens
• Cheryl Grace, M.S. CCC-SLP
• Gracehealth, PLLC
• Graham Dermatology Center, P.C.
• Joni Lia Graham, LPC-CANDIDATE
• Kaylee Graham
• Patricia Lynn Graham, M.S. SLP
• Wendell Nathaniel Graham
• Kelsey Granger

• Physical Therapist in Edmond, OK
• Providers in Edmond, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2022; 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.