Provider Demographics
NPI:1447337969
Name:BLANKENSHIP, JARED ROY (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ROY
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-0024
Mailing Address - Country:US
Mailing Address - Phone:740-550-4128
Mailing Address - Fax:740-422-0516
Practice Address - Street 1:3748 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1181
Practice Address - Country:US
Practice Address - Phone:740-550-4128
Practice Address - Fax:740-422-0516
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 05972225200000X
OHPT016038225100000X
WV003396225100000X
KYPTA A01986225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant