Blaq Therapy
Legal Business Name
Blaq Therapy
NPI Number
1609646256
NPI Type
Organization
Enumeration Date
01/04/2024
Specialties
(Taxonomies)Name
Code
221700000X
1041C0700X
103TC1900X
101YM0800X
225A00000X
364SP0808X
363LP0808X
163WP0808X
2084P0800X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 714
24073 CRESCENT ST
City
Mattawan
Mattawan
State
MI
MI
Postal Code
49071-0714
49071-8457
Country
US
US
Telephone Number
N/A
(734) 802-7667
Authorized Official
Name
Anter Abdallah
Title or Position
CREDENTIALER
Telephone Number
(734) 802-7667
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 01/04/2024