Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT30492 | FL |
NPI | 1003284316 |
---|---|
Provider Name | Jessica Dailey |
First Address | Jacksonville, FL 32223-8618 |
Second Address | Jacksonville, FL 32223-8618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 03/09/2015 |