MEDICARE: ROBERT WEBSTER BLAKEWELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	16777	CA

General Provider Information

NPI Number	:	1528488277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WEBSTER BLAKEWELL PT

Provider Business Mailing Address
First Line	:	1200 B GALE WILSON BLVD
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3552
Country	:	US
Telephone Number	:	707-624-7470
Fax Number	:

Provider Business Practice Location Address
First Line	:	3446 BROWNS VALLEY RD
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9339
Country	:	US
Telephone Number	:	707-624-7470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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