Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
6319 E US HIGHWAY, SUITE 9, AVON, IN 46123-4612
(317) 707-7151
Mailing address
6555 E COUNTY ROAD 700 N, BROWNSBURG, IN 46112-9024
(925) 549-0467
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT22007253
IN
Other
Enumeration date
11/20/2020
Last updated
11/20/2020
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