Healthcare Provider Details

I. General information

NPI: 1871955930
Provider Name (Legal Business Name): BLAKE PRATT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

2615 COVE CAY DR 205
CLEARWATER FL
33760-1365
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT14647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: