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MR. RUSSELL BLAKE JASPER PT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1700037835

Individual Registrant:
MR. RUSSELL BLAKE JASPER PT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
706 HOLLY ST  MC GEHEE, AR 71654-2111 US
Tel: 870-222-3126  Fax: 870-222-3270

Contact information for business:
706 HOLLY ST  MC GEHEE, AR 71654-2111 US
Tel: 870-222-3126  Fax: 870-222-3270

Registration Information:
NPI: 1700037835
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
ARPT2988

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PT LICENSE NUMBERPT2988AR01




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