Provider Demographics
NPI:1891117925
Name:MCAFEE, BLAKE MATTHEW (DPT)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:MATTHEW
Last Name:MCAFEE
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 1:1866 ROUTE 16
Mailing Address - Street 2:
Mailing Address - City:SHIPMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62685-6053
Mailing Address - Country:US
Mailing Address - Phone:618-593-2246
Mailing Address - Fax:
Practice Address - Street 1:1719 CLAWSON ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4702
Practice Address - Country:US
Practice Address - Phone:618-462-1133
Practice Address - Fax:618-462-3736
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist