Individual
KALLIE J BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1574 154TH AVE NW, ANDOVER, MN 55304-4788
(763) 443-8108
Mailing address
1574 154TH AVE NW, ANDOVER, MN 55304-4788
(763) 443-8108
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/24/2011
Last updated
10/18/2016
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