Individual
MR. TRENT ALTON BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
1489 S HIGLEY RD, STE 101, GILBERT, AZ 85296-4776
(480) 457-8800
(480) 457-8885
Mailing address
1489 S HIGLEY RD, STE 101, GILBERT, AZ 85296-4776
(480) 457-8800
(480) 457-8885
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0661
AZ
363A00000X
Physician Assistant
Primary
4298
AZ
Other
Enumeration date
06/16/2006
Last updated
10/24/2011
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