Individual
JAMES BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2126 N 18TH ST, PHILADELPHIA, PA 19121-1623
(443) 610-0176
Mailing address
5629 SAGRA RD, BALTIMORE, MD 21239-2825
(443) 610-0176
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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