Individual
MR. BLAKE SCOTT BUETOW
Active
Individual
MR. BLAKE SCOTT BUETOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
7587
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052N1BU
BLUE CROSS BLUE SHIELD
—
05
—
765105000
—
MN
Enumeration date
03/06/2007
Last updated
04/08/2020
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