Healthcare Provider Details

I. General information

NPI: 1336080589
Provider Name (Legal Business Name): JESSICA BLOSSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD
GLENDALE AZ
85306-4660
US

IV. Provider business mailing address

5639 W CROCUS DR
GLENDALE AZ
85306-4229
US

V. Phone/Fax

Practice location:
  • Phone: 480-935-0614
  • Fax:
Mailing address:
  • Phone: 602-448-7106
  • Fax: 602-448-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-009901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: