Brendon Blake, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7433 Issued in GA

Practice address

4754 Martin Rd
Suite 200
Flowery Branch, GA 30542-3507

Phone

(770) 967-4377

Fax

(770) 967-8077

NPI assigned

Jun 3, 2006

Last updated

Dec 12, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Back in the Game Physical Therapy, IncGroup PAC ID 9133380082, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Back in the Game Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Flowery Branch, GA
  • NPI 1962669275
  Medicare reassignment Care Compare group NPD
• Atlanta Rehabilitation and Performance Center

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1013789205
  NPD (past)
• Atlanta Rehabilitation and Performance Center

  dba nMotion Physical Therapy

  • Physical Therapy Clinic/Center
  • Cleveland, GA
  • NPI 1982797494
  NPD (past)
• High Performance Physical Therapy Centers

  dba Atlanta Falcons Physical Therapy Centers

  • Physical Therapist
  • Suwanee, GA
  • NPI 1467645689
  NPD (past)
• Lanier Therapy in Motion

  • Physical Therapist
  • Gainesville, GA
  • NPI 1568400968
  NPD (past)

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1508804428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "BRENDON",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "7433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "857620906E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202I654821",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beatrice a. Santelli, Inc.
• Kimberly Anne Belangee, FNP-BC
• Steven Benjamin, MS, RD, CSSD, CSCS
• Salman Bhatti, OD
• Staci Sandler Blackmore, PHARMD
• Gina Renee Blake, P.T.
• Eric L Bohn, M.D.
• Trevor Bond, DPT
• Booker Oral Surgery & Implant Center PC
• Reginald Douglas Booker, D.D.S.

• Physical Therapist in Flowery Branch, GA
• Providers in Flowery Branch, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; 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.