Organization
BLAKE PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF BLAKE (OWNER)
(310) 392-7889
Entity
Organization
Contact information
Practice address
1714 17TH ST, SANTA MONICA, CA 90404-4410
(310) 392-7889
(310) 314-4431
Mailing address
1714 17TH ST, SANTA MONICA, CA 90404-4410
(310) 392-7889
(310) 314-4431
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT17676
CA
Other
Enumeration date
03/15/2006
Last updated
12/04/2017
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