Individual
STEPHEN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
10901 N RODNEY PARHAM RD, SUITE 7A, LITTLE ROCK, AR 72212-4114
(501) 301-4530
(501) 251-1165
Mailing address
10901 N RODNEY PARHAM RD, SUITE 7A, LITTLE ROCK, AR 72212-4114
(501) 301-4530
(501) 251-1165
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT 3869
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 3869
ARPT LICENSE 3869
AR
Enumeration date
08/05/2014
Last updated
08/05/2014
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