Individual
MIKHAIL YATSISHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
13990 BARTRAM PARK BLVD UNIT 422, JACKSONVILLE, FL 32258-5546
(315) 395-6901
Mailing address
13990 BARTRAM PARK BLVD UNIT 422, JACKSONVILLE, FL 32258-5546
(315) 395-6901
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
29230
FL
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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