Individual
WILLIAM BLAKE MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1693 SW CHANDLER AVE, SUITE 140, BEND, OR 97702-3236
(541) 390-0523
(541) 787-4383
Mailing address
PO BOX 72, BEND, OR 97709-0072
(541) 390-0523
(541) 787-4383
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4366
OR
Other
Enumeration date
06/23/2010
Last updated
04/14/2016
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