Individual
SHARON A BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
606 S 9TH ST, LEESBURG, FL 34748-6320
(352) 805-4404
Mailing address
2980 W BEAUMONT LN, EUSTIS, FL 32726-2071
(773) 837-2921
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT10709
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14535847
—
FL
Enumeration date
09/05/2019
Last updated
09/05/2019
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