Individual
BOAZ BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
7502 FONDREN RD, HOUSTON, TX 77074-3204
(281) 649-3328
Mailing address
7703 FONDREN RD, HOUSTON, TX 77074-4607
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/09/2011
Last updated
02/09/2011
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