Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01371700 | NJ |
NPI | 1003114026 |
---|---|
Provider Name | Jacob R Schuck |
First Address | Toms River, NJ 08755-1292 |
Second Address | Toms River, NJ 08755-1292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 28/07/2015 |