Provider Demographics
NPI:1972817773
Name:BLAKE FRANCES, KELLY LAURAINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LAURAINE
Last Name:BLAKE FRANCES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7654 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1869
Mailing Address - Country:US
Mailing Address - Phone:954-597-6666
Mailing Address - Fax:954-597-6677
Practice Address - Street 1:7654 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-597-6666
Practice Address - Fax:954-597-6677
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist