Provider Demographics
NPI:1528627320
Name:BLAKE, ABBIGAIL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ABBIGAIL
Other - Middle Name:
Other - Last Name:RISTOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0002
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1501 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1257
Practice Address - Country:US
Practice Address - Phone:715-568-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist