Individual
BREANNA BLACKSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7016 W 300 S, MORGANTOWN, IN 46160-9691
(765) 894-5116
Mailing address
7016 W 300 S, MORGANTOWN, IN 46160-9691
(765) 894-5116
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/07/2015
Last updated
05/07/2015
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