Provider Demographics
NPI:1609120351
Name:ABOULHOSN, JESSICA L (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:ABOULHOSN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ODEGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5924
Mailing Address - Street 2:7208 E. CAVE CREEK RD
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5924
Mailing Address - Country:US
Mailing Address - Phone:480-488-9095
Mailing Address - Fax:480-488-2862
Practice Address - Street 1:7208 E. CAVE CREEK ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-488-9095
Practice Address - Fax:480-488-2862
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ100622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ92366Medicare PIN