Individual
MRS. LEA SHANNON JACUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9601 INTERSTATE 630 EXIT 7, LITTLE ROCK, AR 72205-7202
(501) 202-7614
Mailing address
3515 N OLIVE ST, NORTH LITTLE ROCK, AR 72116-8769
(501) 993-0342
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT 2684
AR
Other
Enumeration date
05/04/2008
Last updated
05/04/2008
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