Individual
JACOB KOTLICKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC/LAT
Contact information
Practice address
3403 ISLAND RD, HOLLYWOOD, FL 33026-1249
(954) 594-1883
Mailing address
3403 ISLAND RD, HOLLYWOOD, FL 33026-1249
(954) 594-1883
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL2874
FL
Other
Enumeration date
07/11/2014
Last updated
07/11/2014
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