Provider Demographics
NPI:1215813035
Name:BLOW, MAXON SLOANE (LAT, ATC, CES)
Entity type:Individual
Prefix:
First Name:MAXON
Middle Name:SLOANE
Last Name:BLOW
Suffix:
Gender:F
Credentials:LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LAKE HOLLINGSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5607
Mailing Address - Country:US
Mailing Address - Phone:863-680-4267
Mailing Address - Fax:863-680-4122
Practice Address - Street 1:111 LAKE HOLLINGSWORTH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5607
Practice Address - Country:US
Practice Address - Phone:863-680-4267
Practice Address - Fax:863-680-4122
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL75692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer