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Individual
JACOB WILSON
Active
Individual
JACOB WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
090148
IA
225100000X
Physical Therapist
Primary
PT60960737
WA
Other
Enumeration date
01/18/2018
Last updated
07/03/2019
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