Individual
MR. JACOB AVERY GOMOKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5818 HARBOUR VIEW BLVD # D, SUITE 150, SUFFOLK, VA 23435-3315
(757) 638-1800
Mailing address
3620 CALVERTON WAY, CHESAPEAKE, VA 23321-4463
(757) 484-9320
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202181
VA
Other
Enumeration date
08/06/2007
Last updated
08/06/2007
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