Provider Demographics
NPI:1184805046
Name:BLAKE, ALLISON E (PT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:E
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:E
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1780 OLD HWY 50 E
Mailing Address - Street 2:SUITE 109
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-3397
Mailing Address - Country:US
Mailing Address - Phone:636-583-7733
Mailing Address - Fax:636-583-7766
Practice Address - Street 1:1780 OLD HWY 50 E
Practice Address - Street 2:SUITE 109
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-3397
Practice Address - Country:US
Practice Address - Phone:636-583-7733
Practice Address - Fax:636-583-7766
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist