Provider Demographics
NPI:1760879209
Name:BASHAM, JARROD SAMPSON (LPTA, BS)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:SAMPSON
Last Name:BASHAM
Suffix:
Gender:M
Credentials:LPTA, BS
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Mailing Address - Street 1:8900 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4615
Mailing Address - Country:US
Mailing Address - Phone:804-288-0033
Mailing Address - Fax:804-288-0035
Practice Address - Street 1:8900 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4615
Practice Address - Country:US
Practice Address - Phone:804-288-0033
Practice Address - Fax:804-288-0035
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306603933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant