Individual
MRS. JENNIFER WALLY BLYSTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, EMT
Contact information
Practice address
5140 WHITE OAK DR, INDIANA, PA 15701-9479
(724) 463-9071
Mailing address
5140 WHITE OAK DR, INDIANA, PA 15701-9479
(724) 463-9071
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT001482A
PA
Other
Enumeration date
03/04/2009
Last updated
03/04/2009
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