Blake, Jeffrey Lee

Blake, Jeffrey Lee is an individual health care provider with primary practice located at 1714 17Th St , Santa Monica CA 90404-4410. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Blake, Jeffrey Lee can be contacted via phone (310) 392-7889.

Contact Information

Primary practice address
1714 17Th St Santa Monica CA 90404-4410
Phone: (310) 392-7889
Fax: (310) 314-4431
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT17676 California

Profile Details

NPI number 1407834781
LBN Legal business name Blake, Jeffrey Lee
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 6th, 2006
Last updated Nov 9th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407834781 NPPES
California Other ZZZ05281Z BLUE SHIELD OF CA

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