Provider Demographics
NPI:1689969701
Name:BLAIR, JARED MERRILL (DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MERRILL
Last Name:BLAIR
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 1:1000 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1265
Mailing Address - Country:US
Mailing Address - Phone:334-283-8032
Mailing Address - Fax:334-283-1136
Practice Address - Street 1:1000 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1265
Practice Address - Country:US
Practice Address - Phone:334-283-8032
Practice Address - Fax:334-283-1136
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist