Healthcare Provider Details

I. General information

NPI: 1831017516
Provider Name (Legal Business Name): ROBERT BLAKE SCOTT LMT, MMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19826 W FLOWER ST
BUCKEYE AZ
85396-3000
US

IV. Provider business mailing address

19826 W FLOWER ST
BUCKEYE AZ
85396-3000
US

V. Phone/Fax

Practice location:
  • Phone: 602-388-8912
  • Fax:
Mailing address:
  • Phone: 602-388-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-28675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: