Healthcare Provider Details

I. General information

NPI: 1457787830
Provider Name (Legal Business Name): JESSICA RAE KLUGH AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PROSPECT ST
EAST STROUDSBURG PA
18301-2956
US

IV. Provider business mailing address

708 PARDEE ST
EASTON PA
18042-1420
US

V. Phone/Fax

Practice location:
  • Phone: 724-766-2724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: