Jessica Grubaugh, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT292055 Issued in CA

Practice address

17231 Park Ave
Sonoma, CA 95476-8507

Phone

(415) 606-3911

NPI assigned

Oct 5, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Santa Rosa Physical Therapy

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1053638635
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1861942575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17231 PARK AVE",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954768507",
            "telephone_number": "415-606-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17231 PARK AVE",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954768507",
            "telephone_number": "415-606-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBAUGH",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT292055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Eileen Graham, M.D.
• Myrna Lillia Granados Johnson, RDH AP
• David Sheridan Gray, MD
• David Alan Greenberg, M.D.
• Robert Greenstein, L.AC.
• Marek Romuald Grzybowski, P.T.
• Cherysh Kemp Gunkle, FNP
• Guy Delorefice M.D. Inc.
• Rebecca Habansky, N.D.
• Lin Teresa Haley, LMFT LPCC

• All providers in Sonoma, CA
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.