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Individual
MR. MARK H BLAKELY
Active
Individual
MR. MARK H BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT,OCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
NC7217
NC
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078RC
BLUE CROSS BLUE SHIELD #
NC
01
—
650016318
RR MEDICARE #
NC
05
—
7211278
—
NC
01
—
B8364
MEDCOST #
NC
Enumeration date
10/03/2006
Last updated
12/11/2024
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