Provider Demographics
NPI:1568034643
Name:WOOD, BLAKE E (PT61183730)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:E
Last Name:WOOD
Suffix:
Gender:M
Credentials:PT61183730
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9379
Mailing Address - Country:US
Mailing Address - Phone:253-925-5623
Mailing Address - Fax:253-661-9771
Practice Address - Street 1:2748 MILTON WAY STE 207
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9379
Practice Address - Country:US
Practice Address - Phone:253-925-5623
Practice Address - Fax:253-661-9771
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61183730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist