Provider Demographics
NPI:1477245520
Name:BLOME, JAYLEN R (DPT)
Entity Type:Individual
Prefix:
First Name:JAYLEN
Middle Name:R
Last Name:BLOME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAYLEN
Other - Middle Name:R
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:50 27TH ST W STE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8602
Practice Address - Country:US
Practice Address - Phone:406-651-9099
Practice Address - Fax:406-651-4332
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-27074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist