Individual
JACK PAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 RHOADS CENTER DR STE A1, CENTERVILLE, OH 45458-3886
(937) 419-3431
Mailing address
7430 WILMINGTON PIKE, DAYTON, OH 45459-5219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT016058
OH
Other
Enumeration date
05/03/2021
Last updated
05/03/2021
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