| Doctor Name: | JENNIFER SUSAN BLADE |
| NPI Number: | 1568873933 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 9779 |
| Business Practice Address: | 3580 Arcade St Vadnais Heights, MN - 551277135 |
| Business Phone Number: | 6519685770 |
| Business Fax Number: | 6519685775 |
| Mailing Address: | 710 Commerce Dr Ste 200, WOODBURY |
| State: | MN |
| Postal Code: | 551254925 |
| Phone Number: | 6519685042 |
| Fax Number: | 6519685904 |
| NPI Enumeration Date: | 05/19/2014 |
| NPI Last Update Date: | 07/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 9779 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |