Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1144632 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1144632 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1144632 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1144632 | TX |
NPI | 1003016510 |
---|---|
Provider Name | Jason Wayne Trojacek |
First Address | Groesbeck, TX 76642 |
Second Address | Groesbeck, TX 76642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 27/12/2019 |