Individual
JACLYN BLADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3075 RIDGE PIKE, EAGLEVILLE, PA 19403
(215) 962-8872
Mailing address
130 YORKSHIRE WAY, HATBORO, PA 19040-2110
(215) 962-8872
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT016691
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100980602
MA NUMBER
PA
Enumeration date
04/22/2009
Last updated
04/22/2009
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