Healthcare Provider Details

I. General information

NPI: 1073822292
Provider Name (Legal Business Name): JASON DANIEL BJALME DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 LA FONTANA BLVD SUITE 113
BOCA RATON FL
33434-5636
US

IV. Provider business mailing address

2070 HOMEWOOD BLVD APT 103
DELRAY BEACH FL
33445-8210
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-8007
  • Fax: 561-451-2365
Mailing address:
  • Phone: 561-272-6430
  • Fax: 561-404-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 25862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: