Robert Cory Blickenstaff, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00009330 Issued in WA

Practice address

717 NE 61St St
Suite 203
Vancouver, WA 98665-8753

Phone

(360) 600-2272

Fax

(877) 362-9612

NPI assigned

Sep 25, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Forward Motion Physical Therapy LLC

  • Orthopedic Physical Therapist
  • Vancouver, WA
  • NPI 1336343789
  NPD (past) Authorized official

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

{
    "created_epoch": "1127606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1760478762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13023 NE HIGHWAY 99",
            "address_2": "SUITE 7 PMB 109",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862767",
            "telephone_number": "360-600-2272",
            "fax_number": "877-362-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 NE 61ST ST",
            "address_2": "SUITE 203",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658753",
            "telephone_number": "360-600-2272",
            "fax_number": "877-362-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICKENSTAFF",
        "first_name": "ROBERT",
        "middle_name": "CORY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-25",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00009330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & IND.",
            "identifier": "179487",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232559",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8382467",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Christine Bledsoe, RN
• Amanda Bleed
• Mark J Blessley, D.C.
• Deanna Kay Blevins, LMP, CR
• Melissa Blickenstaff, MSPT
• Robert D Bloch, MD
• Jennifer Lauren Blocher, M.S.
• Carlo Block-Magno
• Jerald Joseph Block, MD
• Madison Rose, Catherine Block, PHARM.D.

• Physical Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.