William Kelly Blackburn, MASSAGE THERAPY

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60751082 Issued in WA

Practice address

24620 Russell Rd Apt D102
Kent, WA 98032-4745

Phone

(941) 276-5651

NPI assigned

Jan 17, 2019

Last updated

Jan 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547683200000",
    "number": "1033683529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 NW GILMAN BLVD STE A",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272454",
            "telephone_number": "941-276-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24620 RUSSELL RD APT D102",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980324745",
            "telephone_number": "941-276-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "WILLIAM",
        "middle_name": "KELLY",
        "credential": "MASSAGE THERAPY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-17",
        "last_updated": "2019-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60751082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tambra Kay Birkebak
• BJ Kim
• Eva Blacconiere, DPT
• Nicole Marie Black
• Blackburn Clinic, Inc. PS (Rebound)
• Sheryl Alice Blake, MSW
• Aisa Marie Blanchard, BS
• Matthew S Blessing, MD
• Joshua Bleustar, LMHC, NCC, ADS
• Lacey M Bliss, ARNP

• Massage Therapist in Kent, WA
• Providers in Kent, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.