Individual
KENNETH BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3310 ARCTIC BLVD STE 102, ANCHORAGE, AK 99503-4576
(907) 297-8679
Mailing address
208 E 23RD AVE, ANCHORAGE, AK 99503-2012
(907) 297-8679
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
101917
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101917
MASSAGE LICENSE
AK
Enumeration date
09/26/2017
Last updated
06/16/2018
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