Provider Demographics
NPI:1346265253
Name:MARLIA, BLAKE MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:MICHAEL
Last Name:MARLIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1300
Mailing Address - Country:US
Mailing Address - Phone:541-523-8888
Mailing Address - Fax:541-523-8889
Practice Address - Street 1:3950 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1300
Practice Address - Country:US
Practice Address - Phone:541-523-8888
Practice Address - Fax:541-523-8889
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228760Medicaid
ORP00245147OtherRAILROAD MEDICARE
ORP00245147OtherRAILROAD MEDICARE
OR109828Medicare PIN