Individual
ALEXA BLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
180 N ADELAIDE ST, NORMAL, IL 61761-2404
(309) 438-3340
Mailing address
709 S MAIN ST, APT 413, NORMAL, IL 61761-4477
(818) 631-1564
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004046
IL
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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