Individual
BLAKE FUNG RODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 539-6600
Mailing address
618 E COUGAR RIDGE RD, DRAPER, UT 84020-7825
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/24/2023
Last updated
06/08/2025
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