Individual
JACOB ETHAN GUERTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2323 TEXAS ST, PECOS, TX 79772-7338
(432) 447-3551
Mailing address
1264 WALDEN OAKS DR APT C, WOODSTOCK, IL 60098-4073
(815) 708-9685
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009521
IL
Other
Enumeration date
03/03/2022
Last updated
03/03/2022
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