Provider Demographics
NPI:1255217600
Name:OWEN, BLAKE (PT)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:OWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NW FLANDERS ST STE G1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3441
Mailing Address - Country:US
Mailing Address - Phone:503-223-1856
Mailing Address - Fax:503-223-1765
Practice Address - Street 1:2330 NW FLANDERS ST STE G1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3441
Practice Address - Country:US
Practice Address - Phone:503-223-1856
Practice Address - Fax:503-223-1765
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR658342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic