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1114928868
BEVAN D BLAKE
SALT LAKE CITY, UT
NPI
1114928868
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: UT 344859-2401)
Enumeration Date
2005-08-03
Last Update Date
2012-10-10
Business Address
-- BEVAN D BLAKE PT, DPT
370 E SOUTH TEMPLE #250
SALT LAKE CITY, UT 84111-1206
Phone number: 801-512-2656
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Mailing Address
-- BEVAN D BLAKE PT, DPT
370 E SOUTH TEMPLE #250
SALT LAKE CITY, UT 84111-1206
Phone number: 801-512-2656
Copy
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