Brian J Blackburn, A.T., C.
Specialist/Technologist, Athletic Trainer in Lexington, SC. Individual provider (NPI-1).
NPI number1649367152
StatusActive
Last updated in NPPESOct 6, 2014
Details
- NPI
- 1649367152
- Entity type
- Individual (NPI-1)
- Name
- Brian J Blackburn
- Credential
- A.T., C.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 6, 2006
- Last updated
- Oct 6, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 379 | SC | Yes |
Practice location
104 Saluda Pointe DrLexington, SC 29072-7295
Phone 803-413-0220
Mailing address
104 Saluda Pointe DrLexington, SC 29072-7295
Phone 803-413-0220
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