Individual
MS. HEIDI SUE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
1519 CENTRAL ST, STOUGHTON, MA 02072-4415
(781) 297-0979
(781) 297-3703
Mailing address
1519 CENTRAL ST, STOUGHTON, MA 02072-4415
(781) 297-0979
(781) 297-3703
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8676
MA
Other
Enumeration date
08/14/2012
Last updated
08/16/2012
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