| Doctor Name: | JODIE MEGAN BLAKE |
| NPI Number: | 1154644136 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 5501011217 |
| Business Practice Address: | 4069 Lake Dr Se Suite 114 Grand Rapids, MI - 495468816 |
| Business Phone Number: | 6167268365 |
| Business Fax Number: | 6167268364 |
| Mailing Address: | 4085 Burton St Se, Suite 200 GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495462444 |
| Phone Number: | 6169744466 |
| Fax Number: | 6169744582 |
| NPI Enumeration Date: | 03/05/2010 |
| NPI Last Update Date: | 08/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501011217 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |