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Individual

BLAKELY PARENT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
107 BAY BRIDGE DR, GULF BREEZE, FL 32561-7428
(850) 291-2393
Mailing address
1517 E GONZALEZ ST, PENSACOLA, FL 32501-3448
(850) 291-2393

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
30010
FL

Other

Enumeration date
10/22/2008
Last updated
10/22/2008
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