Individual
DAKOTA STORM BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
319 BROADWAY, FORT EDWARD, NY 12828-1221
(518) 746-0700
Mailing address
597 SALMON RIVER RD, PLATTSBURGH, NY 12901-7637
(518) 572-7494
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
012276-01
NY
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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