Provider Demographics
NPI:1558767343
Name:BAUM MEHUS, JESSICA S (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:BAUM MEHUS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6382 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 S 11TH ST
Practice Address - Street 2:MEMORIAL FIELD HOUSE
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15705-1030
Practice Address - Country:US
Practice Address - Phone:724-357-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0035052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer