Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT028216 | PA |
NPI | 1033743463 |
---|---|
Provider Name | Jacob Lawrence |
First Address | King Of Prussia, PA 19406-1495 |
Second Address | Royersford, PA 19468-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 25/02/2020 |