Individual
MRS. JACQUELINE ANN MAILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1075 US HIGHWAY 17 S, ELIZABETH CITY, NC 27909-7628
(252) 338-3975
Mailing address
201 PINELAKE DR, ELIZABETH CITY, NC 27909-3287
(252) 331-2342
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160002895
IL
225200000X
Physical Therapy Assistant
2306602684
VA
225200000X
Physical Therapy Assistant
Primary
4152
NC
225200000X
Physical Therapy Assistant
PTA002011
GA
Other
Enumeration date
06/18/2009
Last updated
06/18/2009
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