Provider Demographics
NPI:1659592640
Name:CLABAUGH, JAYE (PT)
Entity Type:Individual
Prefix:
First Name:JAYE
Middle Name:
Last Name:CLABAUGH
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 1:301 N FAIRFAX ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2635
Mailing Address - Country:US
Mailing Address - Phone:703-836-1083
Mailing Address - Fax:
Practice Address - Street 1:301 N FAIRFAX ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2635
Practice Address - Country:US
Practice Address - Phone:703-836-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050019432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA270929OtherMAMSI