JAY SANVICTORES ICASIANO

WABASH, IN
NPI1255904728
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: IN  06006321)
Enumeration Date2021-07-21
Last Update Date2021-07-21
Business Address
JAY SANVICTORES ICASIANO
1955 VERNON ST
WABASH, IN 46992-4026
Phone number: 260-563-8438
Mailing Address
JAY SANVICTORES ICASIANO
866 SIGNATURE ST APT B
BOURBONNAIS, IL 60914-9216
Phone number: 217-381-0262
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