MARK WILLIAM BLACKLEY (NPI# 1215988605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215988605 |
| Entity Type | Individual |
| Full Name | MARK WILLIAM BLACKLEY |
| Practice Address |
Physical Therapy Clinic Usa Meddac, Evans Army Community Hospital Fort Carson CO 80913-4604 |
| Mailing Address |
1650 Cochrane Cir, Attn: Credentials Office Usa Meddac, Evans Army Community Hospital Fort Carson CO 80913-4604 |
| Practice Telephone | 7195267120 |
| Mailing Telephone | 7195267844 |
| Mailing Fax Number | 7195267984 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251E1300X |
Physical Therapist Specialization: Electrophysiology, Clinical |
2788 | CO | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
PHYSICAL THERAPY CLINIC USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL |
| City | FORT CARSON |
| State | CO |
| Zip Code | 80913-4604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326651498 | Christopher M Juneau | Physical Therapist | Us Air Force/ Fort Carson, 8420 Skyraider Rd, Colorado Springs, AA 80913 | 2020-08-28 |
| 1003433640 | Denise Marie Cacho | Dentist | Smith Dental Clinic, 2280 Hogan St. Blgd 1561, Fort Carson, CO 80913 | 2020-06-30 |
| 1497378053 | Ivan Sergeyevich Koutsopatriy | Dentist | Us Army Dental Health Activity 1667 Cochrane Circle, Bldg 7495, Fort Carson, CO 80913 | 2020-05-18 |
| 1396293478 | Kayla Howerton | Audiologist | 8901 Wetzel Ave, Bldg 1525, Fort Carson, CO 80913 | 2016-09-16 |
| 1922472125 | Danell Pugh | Social Worker | Bldg 1657, Fort Carson, CO 80913 | 2015-11-25 |
| 1750761136 | Colin Michael Kenny | Internal Medicine | Evans Army Community Hospital. 1650 Cochrane Cir B7500, Fort Carson, CO 80913 | 2015-06-01 |
| 1740689736 | Rachel Edwards | Speech-Language Pathologist | Evans Community Hospital, 1650 Cochrane Circle, Fort Carson, CO 80913 | 2014-08-15 |
| 1841617859 | Douglas Foote | Social Worker | 1657 Prussman, Ft. Carson, CO 80913 | 2014-03-27 |
| 1649619396 | Brigette Marie Grimes | Dietitian, Registered | Building 1435, 4th Infantry Division, Division Surgeon, Fort Carson, CO 80913 | 2013-06-17 |
| 1467895318 | Evans Army Community Hospital | Clinic/Center | Bldg 2361 Titus Blvd, Ft Carson, CO 80913 | 2013-04-10 |
| Find all providers in zip 80913 | ||||
| Taxonomy Code | 2251E1300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Electrophysiology, Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982797338 | Elizabeth Rusch | Physical Therapist | 601 E 18th Ave Ste 130, Denver, CO 80203-1493 | 2006-09-30 |
| City | FORT CARSON |
| Zip Code | 80913 |
Please comment or provide details below to improve the information on MARK WILLIAM BLACKLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.