Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 40PTQA00834400 | NJ |
NPI | 1225579097 |
---|---|
Provider Name | Mr. John Jumaoas |
First Address | Summit, NJ 07901-3533 |
Second Address | Summit, NJ 07901-3533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |