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General NPI Number Information
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NPI Number | 1871222570
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Entity Type | Individual
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Provider Name | HERBERT ALLEN BLACKWELL JR. MT
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 3630 GEORGE WASHINGTON HWY SUITE A
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City | YORKTOWN
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State | VA
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Zip | 23693-2360
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Country | US
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Telephone | 757-725-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 108 JEFFERYS DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-3022
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Country | US
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Telephone | 757-725-0617
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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 | 0019010331
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License Number State | VA
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