Individual
JERRY JOSEPH BOURASSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPSIT
Contact information
Practice address
146 S GRANITE ST, PRESCOTT, AZ 86303-4710
(928) 717-3236
Mailing address
146 S GRANITE ST, PRESCOTT, AZ 86303-4710
(928) 717-3236
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1370
AZ
Other
Enumeration date
02/07/2008
Last updated
02/07/2008
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