Individual
STEPHEN PAUL BLAKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
711 W BRANNAN ISLAND RD SPC 21, ISLETON, CA 95641-9761
(916) 600-1430
Mailing address
PO BOX 402, ISLETON, CA 95641-0402
(916) 600-1430
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17860
CA
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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