Provider Demographics
NPI:1245641141
Name:BABICH, JESSICA ROSE (PT,DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:BABICH
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 78TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2099
Mailing Address - Country:US
Mailing Address - Phone:810-923-1493
Mailing Address - Fax:
Practice Address - Street 1:260 E 78TH ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2099
Practice Address - Country:US
Practice Address - Phone:810-923-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10880225100000X
NY041438-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist