Individual
BLAKE TIEDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
645 32ND AVE SW, STE A, CEDAR RAPIDS, IA 52404-3907
(319) 363-2901
(319) 363-2903
Mailing address
3290 RIDGEWAY DR, STE 3, CORALVILLE, IA 52241
(319) 665-2630
(319) 665-2631
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
004341
IA
Other
Enumeration date
02/23/2009
Last updated
03/04/2020
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