Individual
JACKIE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 COMMUNITY ST, WHEELING, WV 26003-5201
(304) 242-3933
Mailing address
100 SUGAR AVE, MOUNDSVILLE, WV 26041-1287
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001182
WV
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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