Individual
MR. KYLE ROSS BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
21300 REDSKIN PARK DR, ASHBURN, VA 20147-6100
(703) 726-7000
Mailing address
21300 REDSKIN PARK DR, ASHBURN, VA 20147-6100
(703) 726-7000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001742
VA
Other
Enumeration date
04/02/2013
Last updated
04/02/2013
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