| NPI | 1477024941 |
|---|---|
| Former Legal Business Name | JAG PHYSICAL THERAPY LLC |
| Entity Type | Organization |
| Authorized Contact | LUANN M TEETSELL Credentialing Manager 718-844-5350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2019-08-06 |