BLAKE EDWARD STOUTENBURG

LAWRENCEVILLE, GA
NPI1831918465
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: UT  3043172-2401)
Enumeration Date2024-10-09
Last Update Date2024-10-09
Business Address
BLAKE EDWARD STOUTENBURG
1000 MEDICAL CENTER BLVD
LAWRENCEVILLE, GA 30046-7694
Phone number: 678-312-1000
Mailing Address
BLAKE EDWARD STOUTENBURG
550 S 300 W UNIT N703
SALT LAKE CITY, UT 84101-2573
Phone number: 248-326-4050
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