Brooke Blackmon

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502008669 Issued in MI

Practice address

15400 Northline Rd
Southgate, MI 48195-2689

Phone

(734) 285-0100

Fax

(734) 285-0101

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1780418590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15400 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952689",
            "telephone_number": "734-285-0100",
            "fax_number": "734-285-0101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20059 King Rd",
            "address_purpose": "LOCATION",
            "city": "Woodhaven",
            "state": "MI",
            "postal_code": "481831032",
            "country_code": "US",
            "telephone_number": "734-365-5112",
            "fax_number": "734-365-5115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502008669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rania Bjaije
• Marian Bjerke, LLP
• Rebecca Black
• Vernetta Perrin Black, TLLP
• Scott Anthony Blackburn, NP
• Lakeisha M Blackwell, M.A.
• Blanzy Clinic
• Aaron J Blanzy, DO
• John E Blanzy, DO
• Andrea Bledsoe

• Physical Therapy Assistant in Southgate, MI
• Providers in Southgate, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; 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.