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Jackie Raver

Physical Therapy Assistant in Panama City, FL. Individual provider (NPI-1).

NPI number1154838696
StatusActive
Last updated in NPPESJan 5, 2018

Details

NPI
1154838696
Entity type
Individual (NPI-1)
Name
Jackie Raver
Sex
Female
Sole proprietor
No
Enumeration date
Jan 5, 2018
Last updated
Jan 5, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225200000X Physical Therapy AssistantPTA27778FLYes

Practice location

3420 E 15th St
Panama City, FL 32405-7425

Phone 850-215-8844

Mailing address

3420 E 15th St
Panama City, FL 32405-7425

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