Individual
JACOB KOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3858 W BROADWAY AVE, ROBBINSDALE, MN 55422-2208
(555) 555-5555
Mailing address
3858 W BROADWAY AVE, ROBBINSDALE, MN 55422-2208
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/30/2015
Last updated
10/11/2016
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