Individual
JACOB R HILLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
35 S LOUISIANA ST STE A140, KENNEWICK, WA 99336-5689
(509) 582-0429
(509) 582-1182
Mailing address
7201 W CLEARWATER AVE STE B101, KENNEWICK, WA 99336-1694
(509) 544-0265
(509) 987-1614
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
62946
OR
225100000X
Physical Therapist
Primary
PT60855203
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62946
STATE LICENSE
OR
01
—
PT60855203
STATE LICENSE
WA
Enumeration date
08/15/2018
Last updated
08/15/2018
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