Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles Blake Sullivan, DPT

Individual provider Physical Therapist · NPI 1821562612

Charles Blake Sullivan, DPT is a Physical Therapist in Paducah, Kentucky. Licensed in Kentucky. Registered with an NPI since 2019.

Licensed in
KY
In the registry since
2019
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

4645 Village Square Dr Ste A
Paducah, KY 42001-7448
Phone: (270) 443-5712
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 007479 (KY)

Record details

NPI number1821562612
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJanuary 15, 2019
Last updated in NPPESJanuary 15, 2019

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