Individual
MRS. BLAKE PHILLIPS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
220 COUNTRY CLUB GATE CTR, SUITE 11, PACIFIC GROVE, CA 93950-5014
(831) 917-9886
Mailing address
309 GRANITE ST, PACIFIC GROVE, CA 93950-3219
(831) 917-9886
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
29705
CA
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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