Individual
STEPHANIE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/LAT
Contact information
Practice address
60 W FULBRIGHT ST, WALNUT RIDGE, AR 72476-9000
(870) 208-5631
Mailing address
211 FAIRGROUNDS RD, HARRISBURG, AR 72432-1306
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT701
AR
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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