Individual
JACOB WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 S MAIN ST, FAIRFIELD, IA 52556-9572
(641) 472-4111
Mailing address
1020 945E ST, MOUNT STERLING, IL 62353-4410
(217) 257-0369
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
090148
IA
225100000X
Physical Therapist
Primary
PT60960737
WA
Other
Enumeration date
01/18/2018
Last updated
07/03/2019
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