Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA30718 | FL |
NPI | 1013682426 |
---|---|
Provider Name | Jarupong Jarukamon |
First Address | Pensacola, FL 32514-4571 |
Second Address | Pensacola, FL 32514-4571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2021 |
Last Update Date | 24/09/2021 |