Individual
MR. BRIAN BLACKSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
611 N LINDSAY ST, HIGH POINT, NC 27262-4300
(336) 802-2250
Mailing address
1112 VERA CT, HIGH POINT, NC 27262-3732
(336) 454-6729
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0413
NC
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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