# BLAKE RANDALL VAN MAANEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1659998284
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 15128-24 | WI | Yes |
| 225100000X | Physical Therapist | — | NULL | — |

## Other

- **Enumeration date:** 06/30/2020
- **Last updated:** 04/13/2026