Individual
JACKEY CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6212 TUDOR WAY, BAKERSFIELD, CA 93306-7067
(661) 871-3133
Mailing address
6212 TUDOR WAY, BAKERSFIELD, CA 93306-7067
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
11163
CA
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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