Individual
JACOB WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 PHELPS ST, SILVERTON, OR 97381-2042
(503) 873-1647
Mailing address
57 GILDERSLEEVE AVE, COLLINSVILLE, CT 06019-3009
(860) 806-4202
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/22/2025
Last updated
08/22/2025
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