Individual
JASON D PENDERGRAPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2441 BELLEVUE AVE, DAYTONA BEACH, FL 32114-5615
(850) 485-4723
Mailing address
1834 WHEELER RD, GULF BREEZE, FL 32563-8824
(850) 485-4723
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4711
FL
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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