Individual
JODIE MEGAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4069 LAKE DR SE, SUITE 114, GRAND RAPIDS, MI 49546-8816
(616) 726-8365
(616) 726-8364
Mailing address
4085 BURTON ST SE, SUITE 200, GRAND RAPIDS, MI 49546-2444
(616) 974-4466
(616) 974-4582
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501011217
MI
Other
Enumeration date
03/05/2010
Last updated
08/03/2010
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