MEDICARE: MR. BENJAMIN J BLANKENSHIP LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7501009175	MI

General Provider Information

NPI Number	:	1750919601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN J BLANKENSHIP LMT

Provider Business Mailing Address
First Line	:	1120 E LONG LAKE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-4974
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 E LONG LAKE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-4974
Country	:	US
Telephone Number	:	855-629-2805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	03/27/2020

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