Individual
CARL EDWARD JAKOWENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
378 GORHAM RD, SCARBOROUGH, ME 04074-9640
(207) 839-2373
Mailing address
378 GORHAM RD, SCARBOROUGH, ME 04074-9640
(207) 839-2373
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA4170
ME
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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