Individual
SAMANTHA BLAZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
PO BOX 141, MALTA, IL 60150-0141
(815) 501-2900
Mailing address
PO BOX 141, MALTA, IL 60150-0141
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096005691
IL
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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