Provider Demographics
NPI:1245929348
Name:BLAKE, ARIANNA
Entity type:Individual
Prefix:
First Name:ARIANNA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARIANNA
Other - Middle Name:
Other - Last Name:SRINIVASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9849 BRISTOL SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5425
Mailing Address - Country:US
Mailing Address - Phone:570-401-8017
Mailing Address - Fax:
Practice Address - Street 1:9849 BRISTOL SQUARE LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5425
Practice Address - Country:US
Practice Address - Phone:570-401-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD29606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist