Individual
DANA DANIEL BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
975 9TH AVE SW STE 320, BESSEMER, AL 35022-7839
(205) 277-2358
Mailing address
405 BELCHER ST, CENTREVILLE, AL 35042-2946
(205) 926-2992
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
GA006565
GA
225100000X
Physical Therapist
Primary
PTH2382
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA006565
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
05/09/2023
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