Provider Demographics
NPI:1619798303
Name:HINTON, BLAKE (DPT)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:HINTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1600
Mailing Address - Country:US
Mailing Address - Phone:815-277-9049
Mailing Address - Fax:815-277-1226
Practice Address - Street 1:706 CENTER RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1600
Practice Address - Country:US
Practice Address - Phone:815-277-9049
Practice Address - Fax:815-277-1226
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist