Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT20761 | FL |
NPI | 1063646925 |
---|---|
Provider Name | Mr. Jason M. Beneciuk |
First Address | Jacksonville, FL 32259-3818 |
Second Address | Jacksonville, FL 32216-4252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 06/05/2009 |