Individual provider Active NPI

Kathryn Blalock, DPT

  • Orthopedic Physical Therapist
  • Fremont, CA
National Provider Identifier
1477856284
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Practice address
704 Mowry Ave
Fremont, CA 94536-4115
Phone
(510) 790-3213
NPI assigned
Dec 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X Primary

Addresses

Primary practice location

704 Mowry Ave
Fremont, CA 94536-4115

Mailing address

35565 Collier PL
Fremont, CA 94536-3311
Phone (510) 386-8360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110324000954 CA Practitioner - Physical Therapist in Private Practice 5193908366 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Schaack Physical Therapy PCGroup PAC ID 0143444992, 8 clinicians

Practice addresses (Care Compare)

801 Sterling Pkwy
Suite 150
Lincoln, CA 95648-7328
Phone (916) 543-7900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
37360CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Swanson Schaack Physical Therapy Orthopedic CurrentSince Aug 23, 2024 Accepting new patients
California Luna Care Physical Therapy PC Orthopedic CurrentSince Feb 7, 2022 Accepting new patients
Schaack Physical Therapy PC CurrentSince Aug 23, 2024 Accepting new patients
Peak Performance Physical Therapy Inc CurrentSince Feb 25, 2011 Accepting new patients

Locations

111 Woodmere Rd
Ste 270
Folsom, CA 95630

2330 E Bidwell St
Ste 130
Folsom, CA 95630

1895 Mowry Ave
Ste 115
Fremont, CA 94538
Phone (510) 790-3213

704 Mowry Ave
Fremont, CA 94536
Phone (510) 790-3213

801 Sterling Pkwy
Ste 150
Lincoln, CA 95648
Phone (916) 543-7900

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

1620 Lead Hill Blvd
Ste 200
Roseville, CA 95661
Phone (916) 789-1111

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1477856284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35565 COLLIER PL",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363311",
            "telephone_number": "510-386-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364115",
            "telephone_number": "510-790-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "KATHRYN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-16",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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.