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General NPI Number Information
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NPI Number | 1164347035
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Entity Type | Individual
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Provider Name | BLAKE MARCELLA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 16180 SE SUNNYSIDE RD STE 204
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City | HAPPY VALLEY
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State | OR
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Zip | 97015-6302
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Country | US
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Telephone | 503-582-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 12634 SE REGENCY VIEW ST
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-9369
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Country | US
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Telephone | 503-438-5434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 66201
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License Number State | OR
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