Jay Sanvictores Icasiano

NPI #1255904728 in Wabash, Indiana

Provider Information

NPI Number: 1255904728
Entity Type: Individual
Name: Jay Sanvictores Icasiano
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jul 21, 2021
Last Updated: Jul 21, 2021

Practice Location

Address: 1955 VERNON ST
City: Wabash
State: Indiana
ZIP Code: 46992-4026
Phone: (260) 563-8438

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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