Healthcare Provider Details

I. General information

NPI: 1477245520
Provider Name (Legal Business Name): JAYLEN R BLOME DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYLEN R HENDERSON

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 27TH ST W STE B
BILLINGS MT
59102-8602
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 406-651-9099
  • Fax: 406-651-4332
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-27074
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: