=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902710775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALRIC BLACKWOOD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 373 BLAIR PARK RD
-----------------------------------------------------
City | WILLISTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05495-8037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-876-7187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 MAPLE LEAF FARM RD
-----------------------------------------------------
City | UNDERHILL
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05489-9358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-835-9785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 164.0002203
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------