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
Mailing address2255 Owens Chapel Rd, Melber, KY 42069-8814

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