Healthcare Provider Details

I. General information

NPI: 1194647586
Provider Name (Legal Business Name): KIMBERLEY BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HILLSBOROUGH ST STE 124
RALEIGH NC
27607-7162
US

IV. Provider business mailing address

3001 HILLSBOROUGH ST STE 124
RALEIGH NC
27607-7162
US

V. Phone/Fax

Practice location:
  • Phone: 919-616-7868
  • Fax: 910-817-4924
Mailing address:
  • Phone: 919-616-7868
  • Fax: 910-817-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: