Individual
JACOB RANDOLPH SHATTUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
600 EAGLE LAKE TRL, ROME, GA 30165-2207
(706) 368-9955
Mailing address
10133 SHERRILL BVLD, UNIT 200, KNOXVILLE, TN 37932
(865) 531-2204
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2136779
TX
225200000X
Physical Therapy Assistant
Primary
CP008628A
GA
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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