Individual
JACOB OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1421 KEMPSVILLE RD STE C, CHESAPEAKE, VA 23320-1406
(757) 410-5322
(757) 548-0670
Mailing address
1421 KEMPSVILLE RD STE C, CHESAPEAKE, VA 23320-1406
(757) 410-5322
(757) 548-0670
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019012484
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019012484
NURSING BOARD LICENSE AS MASSAGE THERAPIST
VA
Enumeration date
10/18/2019
Last updated
10/18/2019
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