| Doctor Name: | DR. STEPHANIE DANIELLE BLAKE |
| NPI Number: | 1003124769 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | 11-04112 |
| Business Practice Address: | 621 W 21st St Andover, KS - 670028498 |
| Business Phone Number: | 3167331349 |
| Business Fax Number: | |
| Mailing Address: | 4141 Danbury St, BEL AIRE |
| State: | KS |
| Postal Code: | 672201933 |
| Phone Number: | 3167442773 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2010 |
| NPI Last Update Date: | 09/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251G0304X |
| License Number: | 11-04112 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Geriatrics |
| Taxonomy Definition: | |