Individual
JACOB JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
916 N DIXIE FWY, NEW SMYRNA BEACH, FL 32168-6220
(386) 426-7885
Mailing address
1400 VOLCO RD, EDGEWATER, FL 32141-6986
(386) 690-2638
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
30319
FL
Other
Enumeration date
09/10/2021
Last updated
09/10/2021
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