Provider Demographics
NPI:1306525977
Name:BLOUNT, COREY LYNDELL
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:LYNDELL
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 CANTERWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-1705
Mailing Address - Country:US
Mailing Address - Phone:832-215-0124
Mailing Address - Fax:
Practice Address - Street 1:5435 CANTERWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-1705
Practice Address - Country:US
Practice Address - Phone:832-215-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
342000000X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company