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

Blake William Siersema, PT, DPT

Individual provider Physical Therapist · NPI 1588361992

Blake William Siersema, PT, DPT is a Physical Therapist in Private Practice in Simpsonville, South Carolina. Qualified in 2022, 4 years ago. Practices with Elite Integrated Therapy Centers LLC, a 52-clinician group and accepts Medicare assignment. Licensed in South Carolina.

Years since qualifying
4
Licensed in
SC
In the registry since
2023
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

719 SE Main St Ste B
Simpsonville, SC 29681-3237
Phone: (864) 233-5128
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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 11728 (SC)

Record details

NPI number1588361992
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedFebruary 15, 2023
Last updated in NPPESFebruary 15, 2023
Certification dateFebruary 15, 2023

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Elite Integrated Therapy Centers Llc — 52 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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