Provider Demographics
NPI:1073023735
Name:DIRCKSEN, BLAKE ARNOLD (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ARNOLD
Last Name:DIRCKSEN
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 83RD ST APT 4W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2844
Mailing Address - Country:US
Mailing Address - Phone:317-385-8525
Mailing Address - Fax:
Practice Address - Street 1:225 E 83RD ST APT 4W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2844
Practice Address - Country:US
Practice Address - Phone:317-385-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic