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

Brooke Blackmon

Individual provider Physical Therapy Assistant · NPI 1780418590

Brooke Blackmon is a Physical Therapy Assistant in Southgate, Michigan. Works from 2 locations. Licensed in Michigan.

Licensed in
MI
In the registry since
2024

Practice location Address checks out

15400 Northline Rd
Southgate, MI 48195-2689
Phone: (734) 285-0100
Fax: (734) 285-0101
Show map & directions

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

Additional practice locations (1)

  • 20059 King Rd, Woodhaven, MI 48183-1032 — (734) 365-5112

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 5502008669 (MI)

Record details

NPI number1780418590
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 26, 2024
Last updated in NPPESJune 27, 2025
Certification dateJune 27, 2025
Mailing address33900 Harper Ave Ste 104, Clinton Twp, MI 48035-4258

Other providers in Southgate