Individual
BLAKE WALLERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
11 BARKINGHAM LN STE C, GREENVILLE, SC 29607-5905
(864) 881-1712
(864) 435-9923
Mailing address
9213 POINTE GRAND PL, SIMPSONVILLE, SC 29680-6997
(803) 810-7033
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11472
SC
Other
Enumeration date
09/01/2022
Last updated
08/16/2024
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