Individual
JACOB MARLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
503 S 18TH ST, LARAMIE, WY 82070-4303
(307) 742-3728
Mailing address
503 S 18TH ST, LARAMIE, WY 82070-4303
(307) 742-3728
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-0829
WY
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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