Individual
JIBU JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 N TELEGRAPH RD, WATERFORD, MI 48328-1878
(248) 836-1000
Mailing address
42265 ARCADIA DR, STERLING HEIGHTS, MI 48313-2605
(586) 218-0225
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501014216
MI
Other
Enumeration date
03/20/2018
Last updated
03/20/2018
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