Provider Demographics
NPI:1801402987
Name:BLAKE, AUBREE NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:AUBREE
Middle Name:NICOLE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16535 110TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9638
Mailing Address - Country:US
Mailing Address - Phone:360-458-3700
Mailing Address - Fax:
Practice Address - Street 1:16535 110TH AVE SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9638
Practice Address - Country:US
Practice Address - Phone:360-458-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61053003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist