Individual
SHIRLEY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
133 CORPORATE DR, SUITE 2, BANGOR, ME 04401-4312
(207) 992-9286
(207) 992-9287
Mailing address
PO BOX 921, BANGOR, ME 04402-0921
(207) 992-2070
(207) 990-5586
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT44
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2294802
AETNA
ME
Enumeration date
08/05/2006
Last updated
07/08/2007
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