Individual
DUSTIN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
308 NE FIRST ST., WINLOCK, WA 98596
(360) 762-8501
Mailing address
126 TENNESSEE RD, WINLOCK, WA 98596-9725
(541) 520-7866
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
61345360
WA
Other
Enumeration date
09/28/2022
Last updated
01/11/2023
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