Provider Demographics
NPI:1770864191
Name:BLUBAUGH, PATRICIA (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BLUBAUGH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 NE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4492
Mailing Address - Country:US
Mailing Address - Phone:352-375-0539
Mailing Address - Fax:
Practice Address - Street 1:737 NE 11TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4492
Practice Address - Country:US
Practice Address - Phone:352-375-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15283OtherMASSAGE THERAPY