Individual
MISS DANA MARIE JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, SCAT
Contact information
Practice address
3971 LEWISVILLE HIGH SCHOOL RD, RICHBURG, SC 29729-9029
(803) 789-1094
Mailing address
3971 LEWISVILLE HIGH SCHOOL RD, RICHBURG, SC 29729-9029
(803) 789-1094
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1404
SC
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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