Individual
BLAKE HARRISON HINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, NASM-PES, MA
Contact information
Practice address
214 MEADOWLANDS DR, BRANDON, MS 39047-9070
(601) 760-2139
Mailing address
214 MEADOWLANDS DR, BRANDON, MS 39047-9070
(601) 760-2139
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0524
MS
Other
Enumeration date
01/07/2015
Last updated
01/07/2015
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