| Doctor Name: | WILLIAM BLAKE MATLOCK |
| NPI Number: | 1013228295 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT |
| License Number: | 4366 |
| Business Practice Address: | 1693 Sw Chandler Ave Suite 140 Bend, OR - 977023236 |
| Business Phone Number: | 5413900523 |
| Business Fax Number: | 5417874383 |
| Mailing Address: | Po Box 72, BEND |
| State: | OR |
| Postal Code: | 977090072 |
| Phone Number: | 5413900523 |
| Fax Number: | 5417874383 |
| NPI Enumeration Date: | 06/23/2010 |
| NPI Last Update Date: | 04/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 4366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |