Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1205482528 |
---|---|
Provider Name | Richard Alexander Jabardo |
First Address | Acworth, GA 30102-6307 |
Second Address | Alpharetta, GA 30004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2019 |
Last Update Date | 13/08/2019 |