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NPI Code Detail

MEDICARE: CECKIA BLEVINS LAT ATC

MEDICARE: CECKIA BLEVINS LAT ATC
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 TrainerSC
22255A2300XAthletic Trainer2020028170MO

General Provider Information

NPI Number : 1184100380
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECKIA BLEVINS LAT ATC
Provider Business Mailing Address
First Line : 1 COLLEGE PARK DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8660
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 COLLEGE PARK DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8660
Country : US
Telephone Number : 864-488-4556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 01/11/2024

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Directions to “ CECKIA BLEVINS LAT ATC” Practice Location

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