NPIMap

Organization Active NPI

Blake Physical Therapy, PC

  • Orthopedic Physical Therapist
  • Santa Monica, CA
National Provider Identifier
1750350476
Registry record updated Dec 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT17676 Issued in CA
Legal business name
BLAKE PHYSICAL THERAPY, PC
Practice address
1714 17TH St
Santa Monica, CA 90404-4410
Phone
(310) 392-7889
Fax
(310) 314-4431
NPI assigned
Mar 15, 2006
Last updated
Dec 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2017

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

Authorized official

Name
Jeff Blake
Title
Owner
Phone
(310) 392-7889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X PT17676 CA Primary

Addresses

Primary practice location

1714 17TH St
Santa Monica, CA 90404-4410

Mailing address

1714 17TH St
Santa Monica, CA 90404-4410
Phone (310) 392-7889

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224000757 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8729974001 Receives reassigned benefits from 20 practitioners
Practice locations: Culver City, CA; Marina del Rey, CA; Santa Monica, CA

National Provider Directory

National Provider Directory

Locations

4820 Lincoln Blvd
Marina del Rey, CA 90292
Phone (310) 392-7889

1714 17th St
Santa Monica, CA 90404
Phone (310) 392-7889

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512345600000",
    "number": "1750350476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 17TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044410",
            "telephone_number": "310-392-7889",
            "fax_number": "310-314-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 17TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904044410",
            "telephone_number": "310-392-7889",
            "fax_number": "310-314-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2017-12-04",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-392-7889"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT17676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.