Individual
GREGORY BLAKE REVETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
910 WARRIOR DR, CENTRE, AL 35960-1099
(601) 479-8614
Mailing address
400 COUNTY ROAD 574, CENTRE, AL 35960-6658
(601) 479-8614
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1093
AL
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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