Individual
JESSADA KANIKNUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3041 DREWSKY LN UNIT 101, FORT MILL, SC 29715-0106
(803) 370-5117
Mailing address
3041 DREWSKY LN UNIT 101, FORT MILL, SC 29715-0106
(803) 370-5117
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2712
SC
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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