Provider Demographics
NPI:1952929127
Name:BLUM, JAMIE OCKNER (DPT)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:OCKNER
Last Name:BLUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3527
Mailing Address - Country:US
Mailing Address - Phone:781-237-1769
Mailing Address - Fax:781-239-9965
Practice Address - Street 1:110 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3527
Practice Address - Country:US
Practice Address - Phone:781-237-1769
Practice Address - Fax:781-239-9965
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020024674225100000X
MAPTL26963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO480087488Medicaid