Individual
JASON ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10814 WILKINS RD, ROUGEMONT, NC 27572
(919) 514-0418
Mailing address
10814 WILKINS RD, ROUGEMONT, NC 27572
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
10359
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10359
MASSAGE LICENSE
NC
Enumeration date
09/18/2015
Last updated
09/18/2015
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