Healthcare Provider Details

I. General information

NPI: 1134043037
Provider Name (Legal Business Name): BLAKE CORDER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 S HIGHWAY 27
SOMERSET KY
42501-3523
US

IV. Provider business mailing address

383 CORBIN CENTER DR
CORBIN KY
40701-1895
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-2006
  • Fax: 606-677-1779
Mailing address:
  • Phone: 606-523-2522
  • Fax: 606-523-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009585
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: