Emily A Blake

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

PTA24202 Issued in FL

Practice address

2627 Riverside Ave FL 3
Jacksonville, FL 32204-4712

Phone

(904) 634-0640

Fax

(904) 634-0203

NPI assigned

Feb 24, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Physical Therapy & Rehabilitation Clinic Inc

  • Physical Therapy Clinic/Center
  • Orange Park, FL
  • NPI 1386618064
  NPD (past)
• Physical Therapy and Rehabiliation Clinic Inc

  • Physical Therapist
  • Orange Park, FL
  • NPI 1508929779
  NPD (past)

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1376903039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD STE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168066",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE FL 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1835 Eastwest Pkwy",
            "address_2": "Suite 16",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320036336",
            "country_code": "US",
            "telephone_number": "904-215-3958",
            "fax_number": "904-215-3970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "EMILY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-24",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "FL",
            "license": "PTA24202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT24202",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aleena Vialva Blake, NP-C
• Brittany Blake, CRNA
• Brittany Blake
• Cynthia E Blake, COTA
• Dion Ericson Blake, IDC
• James C Blake
• Kenneth Leon Blake Jr., BS
• Maja Kristin Kuranz Blake, DO
• Sabrina Blake
• Steven Blake, MD

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; 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.