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Individual
JAEDON FLAKE
Active
Individual
JAEDON FLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
1011890
MN
146N00000X
Basic Emergency Medical Technician
2019032972
UT
225100000X
Physical Therapist
12715
MN
225100000X
Physical Therapist
Primary
12925560-2401
UT
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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