Individual
DR. JACOB LAWRENCE CENTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
10840 LITTLE PATUXENT PKWY STE 105, COLUMBIA, MD 21044-3254
(410) 730-2028
Mailing address
468 GLEN MAR RD APT B4, GLEN BURNIE, MD 21061-7074
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
27852
MD
Other
Enumeration date
02/11/2020
Last updated
02/11/2020
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