Individual
DANIEL L JACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1185 TO LANI DR, STONE MOUNTAIN, GA 30083-5361
(404) 298-7708
Mailing address
1185 TO LANI DR, STONE MOUNTAIN, GA 30083-5361
(404) 298-7708
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009595
GA
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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