Individual
JACOB PAUL VIRGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 703-1227
Mailing address
8642 JEFFFERSON AVENUE, MUNSTER, IN 46321
(708) 856-6302
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05011570A
IN
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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