MEDICARE: BLAKE MARTIN EDWARD PARSON

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	293797	CA

General Provider Information

NPI Number	:	1851803191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE MARTIN EDWARD PARSON

Provider Business Mailing Address
First Line	:	10190 CULVER BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3152
Country	:	US
Telephone Number	:	310-837-9700
Fax Number	:	310-837-9701

Provider Business Practice Location Address
First Line	:	10190 CULVER BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3152
Country	:	US
Telephone Number	:	310-837-9700
Fax Number	:	310-837-9701

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	01/06/2022

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Directions to “ BLAKE MARTIN EDWARD PARSON ” Practice Location

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