Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT9592 | FL |
NPI | 1316348717 |
---|---|
Provider Name | Janice Chan Sajulga |
First Address | Lakeland, FL 33810-3852 |
Second Address | Lakeland, FL 33810-3852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 04/09/2014 |