Provider Demographics
NPI:1639773112
Name:BOBEDA, JESSICA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BOBEDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:ALAMEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1395 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3876
Mailing Address - Country:US
Mailing Address - Phone:408-846-6000
Mailing Address - Fax:408-512-2240
Practice Address - Street 1:1395 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3876
Practice Address - Country:US
Practice Address - Phone:408-846-6000
Practice Address - Fax:408-512-2240
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist