Provider Demographics
NPI:1891131579
Name:BLAIKIE, ANGELA JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:BLAIKIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 NATOMA STREET
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:509-863-6163
Mailing Address - Fax:
Practice Address - Street 1:115 NATOMA STREET
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:916-353-2279
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist