Individual
MR. RUSSELL BLAKE JASPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
210 N. SECOND STREET, MC GEHEE, AR 71654-2111
(870) 265-1074
Mailing address
PO BOX 183, MC GEHEE, AR 71654-0183
(870) 265-1074
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2988
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201955721
—
AR
01
—
5AU27
BCBS
AR
Enumeration date
10/07/2008
Last updated
04/14/2025
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