Blake, Bevan D

Blake, Bevan D is an individual health care provider with primary practice located at 370 E South Temple #250, Salt Lake City UT 84111-1206. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Blake, Bevan D can be contacted via phone (801) 512-2656.

Contact Information

Primary practice address
370 E South Temple #250 Salt Lake City UT 84111-1206
Phone: (801) 512-2656
Fax: (801) 906-0336
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 344859-2401 Utah

Profile Details

NPI number 1114928868
LBN Legal business name Blake, Bevan D
Credentials PT, DPT
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2005
Last updated Oct 10th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114928868 NPPES
Utah Other 64-00731 UNITED HEALTHCARE
Utah Other 68963 UNITED HEALTHCARE
Utah Other 870388269BR1 UNITED HEALTHCARE
Utah Other CJ9402 UNITED HEALTHCARE
Utah Other 34485924000001 UNITED HEALTHCARE
Utah Other 5417 UNITED HEALTHCARE

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