Provider Demographics
NPI:1033807664
Name:BLUBAUGH, JESSICA ELAINE (PT, DPT, FMT, EIS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELAINE
Last Name:BLUBAUGH
Suffix:
Gender:F
Credentials:PT, DPT, FMT, EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5698
Mailing Address - Country:US
Mailing Address - Phone:317-419-0372
Mailing Address - Fax:
Practice Address - Street 1:6125 INWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5698
Practice Address - Country:US
Practice Address - Phone:317-419-0372
Practice Address - Fax:812-379-8047
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018939225100000X
IN05013976A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist