Individual
CHANELLE SOUROU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7749 NORMANDY BLVD, JACKSONVILLE, FL 32221-7657
(904) 345-7600
Mailing address
931 N ORANGE ST, ST AUGUSTINE, FL 32084-0964
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT32300
FL
Other
Enumeration date
02/15/2017
Last updated
02/15/2017
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