Stephen Paul Blakley, CMT
Individual provider Active NPI Massage Therapist · Isleton, CA
NPI 1235736505 · NPPES record last updated Oct 8, 2020
Key facts
- NPI
- 1235736505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 17860 (CA)
- Practice address
- 711 W Brannan Island Rd SPC 21
Isleton, CA 95641-9761 - Phone
- (916) 600-1430
- NPI assigned
- Oct 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 17860 | CA | MD | Surgical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 17860 | CA | Yes |
Addresses
Primary practice location
711 W Brannan Island Rd SPC 21
Isleton, CA 95641-9761
Mailing address
PO Box 402
Isleton, CA 95641-0402
Phone (916) 600-1430
Other providers in Isleton, CA
All providers in Isleton, CA · Massage Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2020. 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.