Individual
BLAKE JAMES AUSTIN WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
11848 BERNARDO PLAZA CT STE 100, SAN DIEGO, CA 92128-2417
(858) 217-2496
Mailing address
840 TURQUOISE ST UNIT 201, SAN DIEGO, CA 92109-1146
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
306495
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306495
PHYSICAL THERAPIST LICENSE NUMBER
CA
Enumeration date
08/05/2024
Last updated
08/05/2024
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