Individual
TOMSENE JOHNETTA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12115 SUTTON LN, BOWIE, MD 20720-3562
(202) 528-3067
Mailing address
PO BOX 7465, LARGO, MD 20792-7465
(202) 528-3067
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M01119
MD
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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