Individual
JACQUES GIDEON VAN DER GLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1721 BALD HILL LOOP, MADISON, NC 27025-7624
(336) 548-9658
Mailing address
1721 BALD HILL LOOP, MADISON, NC 27025-7624
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P4116
NC
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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