Individual
MR. JACOB RYAN HURLBURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6908 N SANTA MONICA BLVD, MILWAUKEE, WI 53217-3942
(414) 352-2082
Mailing address
1123 6TH AVE, GRAFTON, WI 53024-1807
(715) 495-4625
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2839-19
WI
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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