Provider Demographics
NPI:1114058401
Name:BLAKE, JOHN SCOTT (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:BLAKE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PRICES CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-9668
Mailing Address - Country:US
Mailing Address - Phone:717-765-4000
Mailing Address - Fax:717-765-3489
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:WAYNESBORO HOSPITAL - PHYSICAL MEDICINE DEPARTMENT
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2353
Practice Address - Country:US
Practice Address - Phone:717-765-4000
Practice Address - Fax:717-765-3489
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE007725225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant