Individual
DOMINIQUE LETICIA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2548 ALEXANDER PL APT 102, CLEARWATER, FL 33763-1175
(727) 543-0904
Mailing address
2548 ALEXANDER PL APT 102, CLEARWATER, FL 33763-1175
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA78556
FL
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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