Individual
DR. STEPHANIE DANIELLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
621 W 21ST ST, ANDOVER, KS 67002-8498
(316) 733-1349
Mailing address
4141 DANBURY ST, BEL AIRE, KS 67220-1933
(316) 744-2773
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
11-04112
KS
Other
Enumeration date
09/15/2010
Last updated
09/15/2010
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