Individual
MISS PAMELA R JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8701 BLIND PASS RD, 305B, ST PETE BEACH, FL 33706-1465
(727) 360-0392
Mailing address
5791 49TH ST N, ST PETERSBURG, FL 33709-2107
(727) 527-2100
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 23366
FL
Other
Enumeration date
09/06/2012
Last updated
09/19/2012
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