Mark William Blackley

Electrophysiology, Clinical NPI1215988605

Summary

About

Mark William Blackley specialises in Electrophysiology, Clinical. currently works in Colorado.

Provider Details

NPI Number 1215988605
Provider Name Mark William Blackley
Credential
Specialization Electrophysiology, Clinical
Medical School Name
Graduation Year
Gender
Entity Type Individual
PAC ID by PECOS
Professional Enrollment ID
Enumeration Date 05/12/2006
Last Update Date 03/31/2021

Contact Details

Business Practice address PHYSICAL THERAPY CLINIC, Fort Carson,
80913-4604 Colorado View on Google Map
Business Practice phone 719-526-7120
Business Practice fax
Mailing address 1650 COCHRANE CIR, ATTN: CREDENTIALS OFFICE, Fort Carson,
80913-4604 Colorado View on Google Map
Other phone 719-526-7844
Other fax 719-526-7984
Email Address shannonfig@domain.com Reval Email Address
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Hospital Affilitation

Practices in Fort Carson

Fort Carson, Colorado

Newsletter for Healthcare Professionals

Provider Taxonomy Details

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1215988605
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Blackley
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Mark
The first name of the provider, if the provider is an individual.
Provider Credential Text PHYSICAL THERAPIST
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 1650 COCHRANE CIR, ATTN: CREDENTIALS OFFICE
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Fort Carson
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Colorado
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 80913-4604
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 719-526-7844
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number 719-526-7984
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address PHYSICAL THERAPY CLINIC
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Fort Carson
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Colorado
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 80913-4604
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 719-526-7120
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date 05/12/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 03/31/2021
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Code #1 2251E1300X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Clinical Electrophysiologic Physical Therapy, who has demonstrated specialized knowledge and skill in electrophysiologic examinations and evaluations and encompasses both the professional and technical components of the observation, recording, analysis, and interpretation of bioelectric muscle and nerve potentials, detected by means of surface or needle electrodes, for the purpose of evaluating the integrity of the neuromuscular system. Electrophysiologic evaluations include, but are not limited to, electrodiagnostic testing, which includes clinical needle electromyography, motor and sensory nerve conduction studies, and other evoked potential procedures.
Healthcare Provider Taxonomy #1
Provider License Number 1 2788
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 CO
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.