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General NPI Number Information
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NPI Number | 1669728499
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Entity Type | Individual
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Provider Name | ANDREW T JACQUAY DPT
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Gender | Male
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 31 LUPI CT SUITE 150
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City | PALM COAST
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State | FL
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Zip | 32137-4761
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Country | US
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Telephone | 386-447-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 13401 SUTTON PARK DR S APT #714
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5266
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Country | US
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Telephone | 859-250-5061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27316
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License Number State | FL
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