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NPI Code Detail

MEDICARE: KYLE BLAKE

MEDICARE: KYLE BLAKE
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
1171100000XAcupuncturistAC60902550WA

General Provider Information

NPI Number : 1881229953
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE BLAKE
Provider Business Mailing Address
First Line : 38612 ALLEN RD S
Second Line :
City : ROY
State : WA
Zip : 98580-9129
Country : US
Telephone Number : 253-455-1479
Fax Number :
Provider Business Practice Location Address
First Line : 503 1ST ST S STE 4
Second Line :
City : YELM
State : WA
Zip : 98597-7634
Country : US
Telephone Number : 360-400-5625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 03/09/2020

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Directions to “ KYLE BLAKE ” Practice Location

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