Individual
MICHAEL BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2925 POLO PKWY, MIDLOTHIAN, VA 23113-1453
(804) 794-7587
(804) 794-4560
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-6200
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305215230
VA
2251X0800X
Orthopedic Physical Therapist
Primary
2305215230
VA
Other
Enumeration date
08/09/2022
Last updated
05/19/2026
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