Provider Demographics
NPI:1962050237
Name:PERKINS, BLAKE E (DPT)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:E
Last Name:PERKINS
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:PO BOX 33396
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-0396
Mailing Address - Country:US
Mailing Address - Phone:440-230-1133
Mailing Address - Fax:440-230-9243
Practice Address - Street 1:9500 MENTOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8714
Practice Address - Country:US
Practice Address - Phone:440-352-1711
Practice Address - Fax:440-352-7562
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018220208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation