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Individual

ZACHARY BLAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
5333 N SHERIDAN RD, CHICAGO, IL 60640-7371
(419) 357-2055
Mailing address
5333 N SHERIDAN RD, CHICAGO, IL 60640-7371

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.006030
IL

Other

Enumeration date
04/09/2013
Last updated
04/09/2013
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