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Individual
PIUS JACOB
Active
Individual
PIUS JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501011904
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501011904
STATE LICENSE
MI
Enumeration date
04/06/2011
Last updated
04/07/2011
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