Provider Demographics
NPI:1437477171
Name:BLOUNT, LAMICHAEL JAMAR (AAS)
Entity Type:Individual
Prefix:
First Name:LAMICHAEL
Middle Name:JAMAR
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26A RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008
Mailing Address - Country:US
Mailing Address - Phone:732-814-8470
Mailing Address - Fax:
Practice Address - Street 1:26A RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-3012
Practice Address - Country:US
Practice Address - Phone:732-814-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00267100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant