Healthcare Provider Details

I. General information

NPI: 1730064767
Provider Name (Legal Business Name): BLAKE PENLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N NEW YORK AVE
WINTER PARK FL
32789-3117
US

IV. Provider business mailing address

9608 SARAMAGO ALY
ORLANDO FL
32827-5022
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: