Individual
BETTY JAKUBIK-RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
740 13TH AVE SW, LARGO, FL 33770-4442
(727) 204-2976
Mailing address
740 13TH AVE SW, LARGO, FL 33770-4442
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9579A
AZ
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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