Provider Demographics
NPI:1881268548
Name:BLAKEY, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BLAKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21942 SHORT BOW CT
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2247
Mailing Address - Country:US
Mailing Address - Phone:301-751-4442
Mailing Address - Fax:
Practice Address - Street 1:23415 THREE NOTCH RD STE 2026
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-4021
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant