Healthcare Provider Details

I. General information

NPI: 1740199603
Provider Name (Legal Business Name): BLAKE GARRETT FIELDS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 W 84TH ST
INDIANAPOLIS IN
46278-1360
US

IV. Provider business mailing address

6040 W 84TH ST
INDIANAPOLIS IN
46278-1360
US

V. Phone/Fax

Practice location:
  • Phone: 317-956-1082
  • Fax:
Mailing address:
  • Phone: 317-956-1082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016503A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: