NPIMap

Individual provider Active NPI

Blake Warner, LMP

  • Massage Therapist
  • Port Orchard, WA
National Provider Identifier
1407151731
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA60200322 Issued in WA
Practice address
450 Port Orchard Blvd
Port Orchard, WA 98366-4705
Phone
(360) 895-2224
NPI assigned
Jan 18, 2011
Last updated
Jan 18, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA60200322 WA Primary

Addresses

Primary practice location

450 Port Orchard Blvd
Port Orchard, WA 98366-4705

Mailing address

637 SW Birch Rd
Port Orchard, WA 98367-9330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MA60200322WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pro Sport and Spine PLLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295308800000",
    "number": "1407151731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 SW BIRCH RD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983679330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 PORT ORCHARD BLVD",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983664705",
            "telephone_number": "360-895-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARNER",
        "first_name": "BLAKE",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-18",
        "last_updated": "2011-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60200322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.