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Contact Information

ADAM BLAKE
2668 E CITIZENS DR STE 5
FAYETTEVILLE, AR72703-4796
 Phone: 479-595-0711
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopedic

2251X0800X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for ADAM BLAKE · (Male)

NPI Number 1275203127
Status Active
Credentials
Entity Individual
Enumeration date 09/13/2021
Last updated 11/11/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • AR License # 4965
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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