Individual
MR. BLAKE SCOTT BUETOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1155 COUNTY ROAD E E STE 120, VADNAIS HEIGHTS, MN 55110-5191
(651) 241-1464
Mailing address
1155 COUNTY ROAD E E STE 120, VADNAIS HEIGHTS, MN 55110-5191
(651) 241-1464
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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