Individual
KEVIN BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
163 VIRGINIA RD, MONTREAT, NC 28757
(704) 740-0657
Mailing address
163 VIRGINIA RD, PO BOX 935, MONTREAT, NC 28757
(704) 740-0657
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
39540533
NC
390200000X
Student in an Organized Health Care Education/Training Program
39540533
NC
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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