Individual
LARA A BLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1640 N CASALOMA DR, APPLETON, WI 54913-8245
(920) 903-8545
Mailing address
2105 E ENTERPRISE AVE, APPLETON, WI 54913-7862
(920) 991-2561
(920) 991-2563
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6128024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40472100
—
WI
Enumeration date
10/25/2006
Last updated
07/11/2025
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