Blake Broeker, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT22207690 Issued in IN

Practice address

8594 E 116TH St Apt 250
Fishers, IN 46038-1581

Phone

(812) 631-0547

NPI assigned

Jul 9, 2022

Sex

Male

Sole proprietor

Yes

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": "1657324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657324800000",
    "number": "1942934674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8594 E 116TH ST APT 250",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460381581",
            "telephone_number": "812-631-0547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8594 E 116TH ST APT 250",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460381581",
            "telephone_number": "812-631-0547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROEKER",
        "first_name": "BLAKE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-09",
        "last_updated": "2022-07-09",
        "certification_date": "2022-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "MT22207690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brightline Community Care
• Rachel Ann Briscoe, MS, JD
• Kiara Britt, ATC
• Sydney Britt
• Allyson Irene Broadstreet, LMHC
• Dylan Brokaw, MD
• Terrance Broussard
• Ramona Suzanne Brown-Lucas, M.A., CCC-SLP
• Gail A Brown, M.D.
• Kaylyn Alisha-Christina Brown, PA-C

• Massage Therapist in Fishers, IN
• Providers in Fishers, IN by specialty
• Massage Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2022; 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.