Healthcare Provider Details

I. General information

NPI: 1902710775
Provider Name (Legal Business Name): ALRIC BLACKWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 BLAIR PARK RD
WILLISTON VT
05495-8037
US

IV. Provider business mailing address

14 MAPLE LEAF FARM RD
UNDERHILL VT
05489-9358
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-7187
  • Fax:
Mailing address:
  • Phone: 631-835-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0002203
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: