Individual
JACOB DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6008 BROWNSBORO PARK BLVD, LOUISVILLE, KY 40207-1295
Mailing address
808 DANA MARIE DR, LOUISVILLE, KY 40223-3408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008310
KY
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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