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

Blake Coughenour

Individual provider Physical Therapist · NPI 1124874375

Blake Coughenour is a Physical Therapist in Private Practice in Waukee, Iowa. Qualified in 2024, 2 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Iowa.

Years since qualifying
2
Licensed in
IA
In the registry since
2024

Practice location Address checks out

128 W Hickman Rd
Waukee, IA 50263-5070
Phone: (515) 309-1819
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 124144 (IA)

Record details

NPI number1124874375
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 29, 2024
Last updated in NPPESMay 28, 2024
Certification dateMay 28, 2024
Mailing address2122 York Rd Ste 300, Oak Brook, IL 60523-1925

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Waukee