Individual
SOL JOHANNA JAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
191 SWANSON AVE STE 102, LAKE HAVASU CITY, AZ 86403-6699
(928) 855-7880
Mailing address
191 SWANSON AVE STE 102, LAKE HAVASU CITY, AZ 86403-6699
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-014722
AZ
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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