Individual
JACK AMBERS QUESENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
969 E STUART DR, GALAX, VA 24333-2407
(276) 238-8118
Mailing address
969 E STUART DR, GALAX, VA 24333-2407
(276) 238-8118
(762) 238-8119
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305212219
LICENSE
VA
Enumeration date
11/01/2018
Last updated
03/22/2022
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