Keith Blackwell, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3956 Issued in OR

Practice address

1166 W 7TH Ave
Eugene, OR 97402-4616

Phone

(458) 210-2940

Fax

(541) 654-4680

NPI assigned

May 30, 2012

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 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Essential Physical Therapy IncGroup PAC ID 6800115817, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17276/brand/1/csg/1/fhir/r4

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.

• Essential Physical Therapy, Inc.

  • Physical Therapist
  • Eugene, OR
  • NPI 1104210756
  Medicare reassignment Care Compare group NPD Authorized official
• Blaker Enterprises Inc

  • Family Nurse Practitioner
  • Eugene, OR
  • NPI 1831378025
  NPD (past)

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1649531328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1166 W 7TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974024616",
            "telephone_number": "458-210-2940",
            "fax_number": "541-654-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1166 W 7TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974024616",
            "telephone_number": "458-210-2940",
            "fax_number": "541-654-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KEITH",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-30",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "3956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "3956",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roy M Blackburn, MD
• Michael Gene Blackmore, LMT
• Kyndra Blacks, LMT
• Carrie Blackwell, LMT
• Karen Renee Blackwell, LCSW
• Shannon Blackwell
• Monica Carola Blaine, MSW
• Gary Q Blair, DC
• Katheryn Diane Blair
• Nathaniel Blair

• Physical Therapist in Eugene, OR
• Providers in Eugene, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.