Active NPI
Keimonte Lemar Blueford Sr., MT
- Massage Therapist
- Surprise, AZ
National Provider Identifier
1447004783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 24433
- Practice address
- 16551 N Dysart Rd Ste 108
Surprise, AZ 85378-3713 - Phone
- (480) 397-1377
- NPI assigned
- Apr 15, 2024
- Last updated
- Apr 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 24433 | AZ | Primary |
Addresses
Primary practice location
16551 N Dysart Rd Ste 108
Surprise, AZ 85378-3713
Mailing address
16551 N Dysart Rd Ste 108
Surprise, AZ 85378-3713
Phone (480) 397-1377
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24433 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1447004783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16551 N DYSART RD STE 108",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853783713",
"telephone_number": "480-397-1377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16551 N DYSART RD STE 108",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853783713",
"telephone_number": "480-397-1377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUEFORD",
"first_name": "KEIMONTE",
"middle_name": "LEMAR",
"name_suffix": "Sr.",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-15",
"last_updated": "2024-04-15",
"certification_date": "2024-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "24433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.