Provider Demographics
NPI:1376146357
Name:ASIS, BLAKE CHRISTIAN (PT)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:CHRISTIAN
Last Name:ASIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2436
Mailing Address - Country:US
Mailing Address - Phone:857-444-1005
Mailing Address - Fax:508-285-4483
Practice Address - Street 1:2 BELMONT STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-0276
Practice Address - Country:US
Practice Address - Phone:857-444-1026
Practice Address - Fax:508-285-4483
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA25169OtherPT LICENSE