Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 26769 | FL |
NPI | 1013338029 |
---|---|
Provider Name | Jessica Jorgensen |
First Address | Palm Beach Gardens, FL 33410-2825 |
Second Address | Palm Beach Gardens, FL 33410-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2013 |
Last Update Date | 27/04/2020 |