Individual
BLAKE KEITH MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
23374 W YUMA RD STE 104, BUCKEYE, AZ 85326-3120
(623) 242-6908
Mailing address
23374 W YUMA RD STE 104, BUCKEYE, AZ 85326-3120
(623) 242-6908
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
LPT-30012
AZ
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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