Individual
BLAKE KOEVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1433 US HIGHWAY 21 S, SPARTA, NC 28675-8641
(336) 846-7227
Mailing address
1433 US HIGHWAY 21 S, SPARTA, NC 28675-8641
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P24419
NC
Other
Enumeration date
09/05/2025
Last updated
09/05/2025
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