Provider Demographics
NPI:1174979926
Name:ROZYCKI, BLAKE T (DO)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:T
Last Name:ROZYCKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:LAUREL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-794-1300
Mailing Address - Fax:423-794-1820
Practice Address - Street 1:301 MED TECH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2641
Practice Address - Country:US
Practice Address - Phone:423-794-1300
Practice Address - Fax:423-794-1820
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4069207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology