Individual
EMILY A BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2627 RIVERSIDE AVE FL 3, JACKSONVILLE, FL 32204-4712
(904) 634-0640
(904) 634-0203
Mailing address
6500 BOWDEN RD STE 103, JACKSONVILLE, FL 32216-8066
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
PTA24202
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT24202
STATE LICENSE
FL
Enumeration date
02/24/2016
Last updated
09/26/2018
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