Healthcare Provider Details

I. General information

NPI: 1447337969
Provider Name (Legal Business Name): JARED ROY BLANKENSHIP DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3748 STATE ROUTE 7
CHESAPEAKE OH
45619-1181
US

IV. Provider business mailing address

PO BOX 24
CHESAPEAKE OH
45619-0024
US

V. Phone/Fax

Practice location:
  • Phone: 740-550-4128
  • Fax: 740-422-0516
Mailing address:
  • Phone: 740-550-4128
  • Fax: 740-422-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016038
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003396
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 05972
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA A01986
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: