Active NPI
Samantha Blazek, LAT, ATC
- Athletic Trainer
- Malta, IL
National Provider Identifier
1306699608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096005691
- Practice address
- PO Box 141
Malta, IL 60150-0141 - Phone
- (815) 501-2900
- NPI assigned
- Apr 8, 2024
- Last updated
- Apr 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096005691 | IL | Primary |
Addresses
Primary practice location
PO Box 141
Malta, IL 60150-0141
Mailing address
PO Box 141
Malta, IL 60150-0141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096005691 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1306699608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 141",
"city": "MALTA",
"state": "IL",
"postal_code": "601500141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PO BOX 141",
"city": "MALTA",
"state": "IL",
"postal_code": "601500141",
"telephone_number": "815-501-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAZEK",
"first_name": "SAMANTHA",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-08",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096005691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malta, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.