Healthcare Provider Details

I. General information

NPI: 1710028881
Provider Name (Legal Business Name): KARSTEN J BLAKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 88TH ST NE SUITE A
MARYSVILLE WA
98270-7228
US

IV. Provider business mailing address

3719 88TH ST NE SUITE A
MARYSVILLE WA
98270-7228
US

V. Phone/Fax

Practice location:
  • Phone: 360-659-9621
  • Fax: 360-659-9621
Mailing address:
  • Phone: 360-659-9621
  • Fax: 360-659-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00006090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: