Individual
JACOB MATTHEW PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1250 W BRIDGE ST, BLACKFOOT, ID 83221-5095
(208) 785-8018
(208) 785-3332
Mailing address
313 PARK AVE, POCATELLO, ID 83201-4506
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-8007
ID
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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