Alexa Blatt, ATC
Individual provider Active NPI Athletic Trainer · Normal, IL
NPI 1528435955 · NPPES record last updated Sep 2, 2015
Key facts
- NPI
- 1528435955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 096.004046 (IL)
- Practice address
- 180 N Adelaide St
Normal, IL 61761-2404 - Phone
- (309) 438-3340
- NPI assigned
- Sep 2, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096.004046 | IL | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096.004046 | IL | Yes |
Addresses
Primary practice location
180 N Adelaide St
Normal, IL 61761-2404
Mailing address
709 S Main St
Apt 413
Normal, IL 61761-4477
Phone (818) 631-1564
Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.