Dustin Blackwell, LMT
Individual provider Active NPI Massage Therapist · Winlock, WA
NPI 1225752744 · NPPES record last updated Jan 11, 2023
Key facts
- NPI
- 1225752744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 61345360 (WA)
- Practice address
- 308 NE First St.
Winlock, WA 98596 - Phone
- (360) 762-8501
- NPI assigned
- Sep 28, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61345360 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myocare LLC | Massage Therapist | Current |
Accepting new patients |
Locations
308 NE First St
Winlock, WA 98596
Phone (360) 762-8501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 61345360 | WA | Yes |
Addresses
Primary practice location
308 NE First St.
Winlock, WA 98596
Mailing address
126 Tennessee Rd
Winlock, WA 98596-9725
Phone (541) 520-7866
Other providers in Winlock, WA
- A W S Inc
- Tina Marie Anderson
- Joshua Bigner
- Kimberly Renee Blackwell
- Shannon Rae Blair
- Karissa Amber Boyovich
- Deborah L Byrd
- Tracy Cagle
All providers in Winlock, WA · Massage Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.