Individual
JACOB BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
325 HANSON ST, WINNEMUCCA, NV 89445-3607
(775) 625-2222
(775) 625-1131
Mailing address
325 HANSON ST, WINNEMUCCA, NV 89445-3607
(775) 625-2222
(775) 625-1131
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2808
NV
Other
Enumeration date
02/14/2013
Last updated
07/22/2016
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