| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JACQLENE JACOB JOHNSON | 1801476296 | 2021-04-10 |
Jacqlene Jacob Johnson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1801476296. Registration indicates Jacqlene Jacob Johnson is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Physical Therapist (Physical Therapist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| Entity Type | Individual |
| Provider Name | Jacqlene Jacob Johnson |
| Practice Office Address | 224 BEACH 20TH ST FAR ROCKAWAY, NY US |
| Practice Office Telephone | 3479264037 |
| Mailing Address | 346 SIP AVE JERSEY CITY, NJ 073066569 US |
| Business Telephone | 4434473230 |
| Code | Practice | License No State |
|---|---|---|
| 225100000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist Physical Therapist Speech/Occupational/Physical Therapy/Chiropractor Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 046821
NY |