Wanda Lynn Blake, R.N. LMT

NPI #1578762803 in Newberry, Florida

Provider Information

NPI Number: 1578762803
Entity Type: Individual
Name: Wanda Lynn Blake, R.N. LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: R.N. LMT
Enumeration Date: Jul 17, 2007
Last Updated: Jul 17, 2007

Practice Location

Address: 1411 SW 252ND TER
City: Newberry
State: Florida
ZIP Code: 32669-4416
Phone: (352) 472-9004

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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