Provider Demographics
NPI:1598345597
Name:SEGURA, BLAIN (AT STUDENT)
Entity Type:Individual
Prefix:
First Name:BLAIN
Middle Name:
Last Name:SEGURA
Suffix:
Gender:M
Credentials:AT STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 SE SPRINGTREE PL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8576
Mailing Address - Country:US
Mailing Address - Phone:772-233-5351
Mailing Address - Fax:
Practice Address - Street 1:2480 SE SPRINGTREE PL
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8576
Practice Address - Country:US
Practice Address - Phone:772-233-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer