Individual
BLAKE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
820 W FOXWOOD DR, RAYMORE, MO 64083-9195
(816) 318-8109
Mailing address
820 W FOXWOOD DR, RAYMORE, MO 64083-9195
(816) 318-8109
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-06836
KS
225100000X
Physical Therapist
Primary
2021026428
MO
Other
Enumeration date
07/07/2021
Last updated
07/07/2021
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