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General NPI Number Information
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NPI Number | 1275918427
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Entity Type | Individual
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Provider Name | TYECHIA BLAKEY MT
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Gender | Female
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 1356 1/2 S. MAIN ST.
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City | HARRISONBURG
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State | VA
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Zip | 22801
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Country | US
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Telephone | 540-383-9448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | BRIDGEWATER
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State | VIRGINIA
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Zip | 22812
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Country | UM
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Telephone | 540-383-9448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019005300
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License Number State | VA
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