Provider Demographics
NPI:1811345036
Name:GILES, BLAKE GARRISON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:GARRISON
Last Name:GILES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 W 92ND AVE
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6302
Mailing Address - Country:US
Mailing Address - Phone:303-412-7035
Mailing Address - Fax:303-412-7993
Practice Address - Street 1:5008 W 92ND AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6302
Practice Address - Country:US
Practice Address - Phone:303-412-7035
Practice Address - Fax:303-412-7993
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist