Individual
BLAKE EDWARD STOUTENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
580 S SAN VICENTE BLVD, LOS ANGELES, CA 90048-4621
(323) 782-1500
Mailing address
1231 E 6600 S, MURRAY, UT 84121-2450
(248) 326-4050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3043172-2401
UT
225100000X
Physical Therapist
308213
CA
Other
Enumeration date
10/09/2024
Last updated
10/20/2025
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