DAKOTA STORM BLAKE

FORT EDWARD, NY
NPI1417594748
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: NY  012276-01)
Enumeration Date2019-12-05
Last Update Date2019-12-05
Business Address
DAKOTA STORM BLAKE PTA
319 BROADWAY
FORT EDWARD, NY 12828-1221
Phone number: 518-746-0700
Mailing Address
DAKOTA STORM BLAKE PTA
597 SALMON RIVER RD
PLATTSBURGH, NY 12901-7637
Phone number: 518-572-7494
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