Active NPI
Blake Logan Bohanan, PT, DPT
- Physical Therapist
- Knoxville, TN
National Provider Identifier
1467042069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13261
- Practice address
- 4589 Kingston Pike
Knoxville, TN 37919-5229 - Phone
- (865) 250-9300
- NPI assigned
- Jan 19, 2021
- Sex
- Male
- 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 | 13261 | TN | Primary |
Addresses
Primary practice location
4589 Kingston Pike
Knoxville, TN 37919-5229
Mailing address
3904 Schaad Rd
Knoxville, TN 37921-2114
Phone (865) 250-9300
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13261 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611014400000",
"number": "1467042069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3904 SCHAAD RD",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379212114",
"telephone_number": "865-250-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4589 KINGSTON PIKE",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379195229",
"telephone_number": "865-250-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHANAN",
"first_name": "BLAKE",
"middle_name": "LOGAN",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-19",
"last_updated": "2021-01-19",
"certification_date": "2021-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "13261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.