Provider Demographics
NPI:1326528712
Name:BLAKE, AARON MAYS (LMP)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MAYS
Last Name:BLAKE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5567 34TH STREET LOOP NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3103
Mailing Address - Country:US
Mailing Address - Phone:253-653-6507
Mailing Address - Fax:
Practice Address - Street 1:16720 SE 271ST ST STE 200
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7342
Practice Address - Country:US
Practice Address - Phone:253-630-5808
Practice Address - Fax:253-630-6438
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist