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Individual
JARED BLANK
Active
Individual
JARED BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
021951-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021951-1
PT LICENSE
NY
Enumeration date
11/21/2006
Last updated
06/16/2014
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