Individual
BLAKE RUSSELL HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 W 75TH ST, KANSAS CITY, MO 64114-1512
(816) 745-6270
Mailing address
4407 NE 45TH TER, KANSAS CITY, MO 64117-1823
(816) 745-6270
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
MO
Other
Enumeration date
09/28/2020
Last updated
09/28/2020
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