Blakelynn Colclasure Bass, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10613 Issued in LA

Practice address

4616 Highway 84 W
Vidalia, LA 71373-3357

Phone

(318) 336-5400

Fax

(318) 336-8622

NPI assigned

Jun 15, 2020

Last updated

Jan 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Core Physical Therapy, LLCGroup PAC ID 2062738172, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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

• Core Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Vidalia, LA
  • NPI 1548659840
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1629693601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 HIGHWAY 84 W",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733357",
            "telephone_number": "318-336-5400",
            "fax_number": "318-336-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 HIGHWAY 84 W",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733357",
            "telephone_number": "318-336-5400",
            "fax_number": "318-336-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "BLAKELYNN",
        "middle_name": "COLCLASURE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "LA",
            "license": "10613",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "10613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2532499",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yvonne Anderson
• Angel Hands Healthcare LLC
• Mark Armstrong, MA MFT
• Ernetria L Banks
• Vontina Lavet Barfield
• Chelsea Bates
• Antrina M Bell, DSW
• Berachah Valley Corporation
• Berachah Valley Corporation
• Jennifer Hootsell Betts, M.S., CCC-SLP

• Physical Therapist in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.