Individual
LAUREN ST JACQUES
Active
Individual
LAUREN ST JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
001083
WV
225100000X
Physical Therapist
Primary
02305004220
VA
2251G0304X
Geriatric Physical Therapist
001083
WV
2251G0304X
Geriatric Physical Therapist
2305004220
VA
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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