Provider Demographics
NPI:1306485628
Name:PRICE, BLAKE (DPT)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 W MUSKEGON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1341
Mailing Address - Country:US
Mailing Address - Phone:517-775-1352
Mailing Address - Fax:
Practice Address - Street 1:9219 WATER ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-9206
Practice Address - Country:US
Practice Address - Phone:231-893-6655
Practice Address - Fax:231-893-4902
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist