Individual
GREGORY L BLASKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3385 DEXTER CT STE 203, DAVENPORT, IA 52807-3471
(563) 332-9312
(563) 332-9316
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01817
IA
225100000X
Physical Therapist
070-005511
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01817
IOWA PT LICENSE NUMBER
IA
01
—
070-005511
ILLINOIS PT LICENSE NO.
IL
Enumeration date
05/10/2006
Last updated
04/11/2012
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