Healthcare Provider Details

I. General information

NPI: 1518574953
Provider Name (Legal Business Name): JESSICA ROSE HOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW JEFFERSON ST APT 15
PORTLAND OR
97201-6064
US

IV. Provider business mailing address

1515 SW JEFFERSON ST APT 15
PORTLAND OR
97201-6064
US

V. Phone/Fax

Practice location:
  • Phone: 407-301-8132
  • Fax:
Mailing address:
  • Phone: 407-301-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA93054
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-25869
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: