Provider Demographics
NPI:1750721270
Name:BLUBAUGH, TERESA (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BLUBAUGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 FOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7934
Mailing Address - Country:US
Mailing Address - Phone:530-677-7334
Mailing Address - Fax:
Practice Address - Street 1:1252 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5822
Practice Address - Country:US
Practice Address - Phone:530-622-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant