Individual
BLAKE KALIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 KENMORE AVE, PONTE VEDRA, FL 32081-0100
(330) 465-3587
Mailing address
90 KENMORE AVE, PONTE VEDRA, FL 32081-0100
(330) 465-3587
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME162651
FL
Other
Enumeration date
05/10/2017
Last updated
11/27/2023
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