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Individual

MR. EDWARD V. JACQUIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P. T.

Contact information

Practice address
947 WOODWAY DR, FENTON, MO 63026-3031
(636) 349-1768
Mailing address
947 WOODWAY DRIVE, FENTON, MO 63026-3031
(636) 349-1768

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00790
MO

Other

Enumeration date
08/28/2008
Last updated
08/28/2008
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