Carter Blackham
Individual provider Active NPI Physical Therapist · Herriman, UT
NPI 1932521986 · NPPES record last updated May 12, 2026
Key facts
- NPI
- 1932521986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 8661479-2401 (UT)
- Practice address
- 13218 S Weatherford LN
Herriman, UT 84096-5001 - Phone
- (435) 669-9191
- NPI assigned
- Jan 10, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140806000264 | UT | Practitioner - Physical Therapist in Private Practice | 9830316488 | Practice locations: Herriman, UT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8661479-2401 | UT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pure Dermatology LLC | Past |
Accepting new patients |
Interoperability endpoints
- https://app.meldrx.com/api/fhir/ez_00334
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8661479-2401 | UT | Yes |
Addresses
Primary practice location
13218 S Weatherford LN
Herriman, UT 84096-5001
Mailing address
13218 S Weatherford LN
Herriman, UT 84096-5001
Phone (435) 669-9191
Other providers in Herriman, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.