Blake Hammond Petersen, DPT
Physical Therapist in Kansas City, MO. Individual provider (NPI-1).
NPI number1063907129
StatusActive
Last updated in NPPESJun 29, 2018
Details
- NPI
- 1063907129
- Entity type
- Individual (NPI-1)
- Name
- Blake Hammond Petersen
- Credential
- DPT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 29, 2018
- Last updated
- Jun 29, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 2018022252 | MO | Yes |
Practice location
5400 N Oak Trfy Ste 103Kansas City, MO 64118-4689
Phone 816-455-0301
Mailing address
5400 N Oak Trfy Ste 103Kansas City, MO 64118-4689
Phone 816-455-0301
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 408 Physical Therapist providers in Kansas City · All 16,914 providers in Kansas City
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