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General NPI Number Information
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NPI Number | 1891117925
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Entity Type | Individual
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Provider Name | BLAKE MATTHEW MCAFEE DPT
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Gender | Male
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 1719 CLAWSON ST
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City | ALTON
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State | IL
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Zip | 62002-4702
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Country | US
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Telephone | 618-462-1133
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Fax | 618-462-3736
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Provider Business Mailing Address
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Address Line | 1866 ROUTE 16
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City | SHIPMAN
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State | IL
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Zip | 62685-6053
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Country | US
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Telephone | 618-593-2246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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