Individual
MR. GREGORY M BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
811 NORTH 1ST STREET, VIENNA, IL 62995
(618) 658-8144
(618) 658-9146
Mailing address
811 NORTH 1ST STREET, VIENNA, IL 62995
(618) 658-8144
(618) 658-9146
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.005246
IL
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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