Healthcare Provider Details

I. General information

NPI: 1922945336
Provider Name (Legal Business Name): JOSEPH ALEXANDER BLAKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 S COLORADO BLVD STE 100
DENVER CO
80246-8019
US

IV. Provider business mailing address

755 S DEXTER ST APT 122
DENVER CO
80246-2100
US

V. Phone/Fax

Practice location:
  • Phone: 720-744-0666
  • Fax:
Mailing address:
  • Phone: 303-392-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0026183
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: