Healthcare Provider Details

I. General information

NPI: 1609120351
Provider Name (Legal Business Name): JESSICA L ABOULHOSN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA L ODEGAARD PT

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 E. CAVE CREEK ROAD SUITE H
CAREFREE AZ
85377
US

IV. Provider business mailing address

PO BOX 5924 7208 E. CAVE CREEK RD
CAREFREE AZ
85377-5924
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9095
  • Fax: 480-488-2862
Mailing address:
  • Phone: 480-488-9095
  • Fax: 480-488-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10062
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: