Individual
JACOB RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
150 JEFFERSON AVE SE STE 100, GRAND RAPIDS, MI 49503-4306
(616) 284-3690
Mailing address
625 KENMOOR AVE SE STE 100, GRAND RAPIDS, MI 49546-2395
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501302189
MI
Other
Enumeration date
09/27/2022
Last updated
11/07/2022
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