Provider Demographics
NPI:1285679399
Name:DEBLASSIO, JODI (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DEBLASSIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1049
Mailing Address - Country:US
Mailing Address - Phone:724-938-0310
Mailing Address - Fax:724-938-0312
Practice Address - Street 1:228 WOOD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1049
Practice Address - Country:US
Practice Address - Phone:724-938-0310
Practice Address - Fax:724-938-0312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013713L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00015935850005Medicaid
PA00015935850005Medicaid