Provider Demographics
NPI:1922183102
Name:BLOUGH, JESSICA (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BLOUGH
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 1:146 FULL CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:MANNS CHOICE
Mailing Address - State:PA
Mailing Address - Zip Code:15550-8957
Mailing Address - Country:US
Mailing Address - Phone:814-623-9075
Mailing Address - Fax:814-623-7336
Practice Address - Street 1:136 DONAHUE MANOR RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-9728
Practice Address - Country:US
Practice Address - Phone:814-623-9075
Practice Address - Fax:814-623-7336
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO11184L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist