Provider Demographics
NPI:1316589310
Name:BLUBAUGH, CARRIE HAMILL
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HAMILL
Last Name:BLUBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1564
Mailing Address - Country:US
Mailing Address - Phone:913-492-1130
Mailing Address - Fax:913-387-0204
Practice Address - Street 1:9701 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1564
Practice Address - Country:US
Practice Address - Phone:913-492-1130
Practice Address - Fax:913-387-0402
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist