Individual
BLAKE RANDALL VAN MAANEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
N91W15750 FALLS PKWY, MENOMONEE FALLS, WI 53051-2301
(262) 532-1100
(262) 532-1409
Mailing address
2651 MARATHON AVE, NEENAH, WI 54956-5080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15128-24
WI
225100000X
Physical Therapist
—
—
Other
Enumeration date
06/30/2020
Last updated
04/13/2026
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