Individual
BLAINE TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
4112 LOOP 306 APT 1811, SAN ANGELO, TX 76904-2305
(325) 340-7994
Mailing address
4112 LOOP 306 APT 1811, SAN ANGELO, TX 76904-2305
(325) 340-7994
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
8982
TX
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/05/2022
Last updated
05/05/2022
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