| Doctor Name: | MR. BRENDON BLAKE |
| NPI Number: | 1508804428 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 7433 |
| Business Practice Address: | 4754 Martin Rd Suite 200 Flowery Branch, GA - 305423507 |
| Business Phone Number: | 7709674377 |
| Business Fax Number: | 7709678077 |
| Mailing Address: | 4754 Martin Rd, Suite 200 FLOWERY BRANCH |
| State: | GA |
| Postal Code: | 305423507 |
| Phone Number: | 7709674377 |
| Fax Number: | 7709678077 |
| NPI Enumeration Date: | 06/03/2006 |
| NPI Last Update Date: | 12/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 7433 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| 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 |