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NPI Code Detail

MEDICARE: MS. MARIA BLOKDIJK ATC-NASM-PES

MEDICARE: MS. MARIA BLOKDIJK ATC-NASM-PES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1639227325
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA BLOKDIJK ATC-NASM-PES
Provider Business Mailing Address
First Line : 24736 HOPKINS ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-1619
Country : US
Telephone Number : 313-563-3962
Fax Number :
Provider Business Practice Location Address
First Line : 6525 2ND AVE
Second Line :
City : DETROIT
State : MI
Zip : 48202-3006
Country : US
Telephone Number : 313-972-4166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MARIA BLOKDIJK ATC-NASM-PES” Practice Location

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