Provider Demographics
NPI:1215996293
Name:BLAKELY, NEAL J (BS, PT)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:J
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:BS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 S MANITO BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 E WESTVIEW CT
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1376
Practice Address - Country:US
Practice Address - Phone:509-465-1749
Practice Address - Fax:509-465-1748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0003710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0108458OtherLABOR & INDUSTRIES
WA8341497Medicaid
WAAB10296Medicare ID - Type Unspecified