Provider Demographics
NPI:1497277412
Name:GALBRAITH, BLAKE LEE (DPT)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:LEE
Last Name:GALBRAITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N 2ND W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1515
Mailing Address - Country:US
Mailing Address - Phone:208-359-2500
Mailing Address - Fax:
Practice Address - Street 1:36 N 2ND W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1515
Practice Address - Country:US
Practice Address - Phone:208-359-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation