Provider Demographics
NPI:1447897475
Name:BARCLAY, JASON MATTHEW (CMT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2923
Mailing Address - Country:US
Mailing Address - Phone:310-736-5929
Mailing Address - Fax:
Practice Address - Street 1:10617 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-4701
Practice Address - Country:US
Practice Address - Phone:310-736-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist