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Individual
JASON LACANLALE
Active
Individual
JASON LACANLALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT297570
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT297570
LICENSE
CA
Enumeration date
11/08/2019
Last updated
04/12/2021
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