Provider Demographics
NPI:1811123490
Name:BLANTON, JAIME L (PT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:BLANTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1108 DRESSER CT
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7328
Mailing Address - Country:US
Mailing Address - Phone:919-876-8302
Mailing Address - Fax:919-954-8706
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-681-1656
Practice Address - Fax:919-668-1451
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist