Robert Blake, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

06609 Issued in OH

Practice address

3705 State Rd
Suite 102
Ashtabula, OH 44004-5957

Phone

(440) 997-0014

NPI assigned

Jun 19, 2014

Last updated

Jun 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1750795571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2217 BENNETT RD",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440572604",
            "telephone_number": "440-428-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 STATE RD",
            "address_2": "SUITE 102",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440045957",
            "telephone_number": "440-997-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ROBERT",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "06609",
            "primary": true
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "OH",
            "license": "06609",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "OH",
            "license": "06609",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OH",
            "license": "06609",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Marie Bittner, FNP-C
• Kirstyn Nicole Blair, KIRSTYN BLAIR COTA/L
• Anthonette Blake
• Mary Ellen Blake, LPCC
• Melanie Hannah Blake
• Tabitha Blevins
• Kyle Sue Bliffin
• Cody Blood, DPT
• Jennifer Bloom, COTA
• Boardman Medical Supply Co

• Physical Therapist in Ashtabula, OH
• Providers in Ashtabula, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.