Provider Demographics
NPI:1003031816
Name:BLAKELY, JAMES (MPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1265 WAYNE AVE STE 308
Mailing Address - Street 2:119 PROFESSIONAL BUILDING
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-801-8095
Mailing Address - Fax:724-801-8147
Practice Address - Street 1:1555 E WADSWORTH AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1617
Practice Address - Country:US
Practice Address - Phone:267-323-2778
Practice Address - Fax:267-323-2774
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20500225100000X
PAPT015918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010859496OtherEIN