Provider Demographics
NPI:1427572478
Name:BLAKE, RUTH MARIAN (PT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIAN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 NW NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5551
Mailing Address - Country:US
Mailing Address - Phone:971-362-3288
Mailing Address - Fax:
Practice Address - Street 1:1027 NW NORMAN AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5551
Practice Address - Country:US
Practice Address - Phone:971-362-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist