Mrs Gina Renee Blake, PT in Flowery Branch, GA - Medicare Physical Therapist Provider

Mrs Gina Renee Blake, PT is a medicare enrolled "Physical Therapist" provider in Flowery Branch, Georgia. Her current practice location is 4754 Martin Rd, Suite 200, Flowery Branch, Georgia. You can reach out to her office (for appointments etc.) via phone at (770) 967-4377.

Mrs Gina Renee Blake is licensed to practice in Georgia (license number 7434) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1053596569.

Contact Information

	Mrs Gina Renee Blake, PT
	4754 Martin Rd, Suite 200, Flowery Branch, GA 30542-3507
	(770) 967-4377
	(770) 967-8077

Map and Direction

Healthcare Provider's Profile

Full Name	Mrs Gina Renee Blake
Gender	Female
Speciality	Physical Therapist
Location	4754 Martin Rd, Flowery Branch, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1053596569
Provider Enumeration Date: 01/03/2008
Last Update Date: 12/12/2011

Medicare PECOS Information:

PECOS PAC ID: 5193796092
Enrollment ID: I20040804000745

Medical Identifiers

Medical identifiers for Mrs Gina Renee Blake such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1053596569	NPI	-	NPPES
11816396	Other	GA	CAQH
20265I4817	Other	GA	MEDICARE PTAN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	7434 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Gina Renee Blake allows following entities to bill medicare on her behalf.

Provider Name	Back In The Game Physical Therapy, Inc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1962669275 PECOS PAC ID: 9133380082 Enrollment ID: O20120419000722

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Gina Renee Blake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Gina Renee Blake, PT 4754 Martin Rd, Suite 200, Flowery Branch, GA 30542-3507 Ph: (770) 967-4377	Mrs Gina Renee Blake, PT 4754 Martin Rd, Suite 200, Flowery Branch, GA 30542-3507 Ph: (770) 967-4377

Reviews and Comments

Physical Therapist in Flowery Branch, GA

Rudo Alice Takawira, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4595 Cantrell Rd, Flowery Branch, GA 30542 Phone: 770-967-2070
Joseph B Taylor, PT,DPT Physical Therapist Medicare: May Accept Medicare Assignments Practice Location: 5887 Spout Springs Rd Ste D403, Flowery Branch, GA 30542 Phone: 770-967-9301 Fax: 770-967-9526
Wonder Therapeutic Services Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4875 Hog Mountain Rd Ste B, Flowery Branch, GA 30542 Phone: 404-406-8272 Fax: 770-965-1008
Trey M Short, DPT Physical Therapist Medicare: May Accept Medicare Assignments Practice Location: 4754 Martin Rd Ste 200, Flowery Branch, GA 30542 Phone: 770-967-4377 Fax: 770-967-8077
Stephen Mayo, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 4754 Martin Rd # 200, Flowery Branch, GA 30542 Phone: 770-967-4377
Atlanta Rehabilitation And Performance Center Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7378 Friendship Springs Blvd Ste A, Flowery Branch, GA 30542 Phone: 770-318-8030 Fax: 770-318-8031

Mrs Gina Renee Blake, PT - Medicare Physical Therapist in Flowery Branch, GA