Individual
JACOB STEVEN LAVERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(712) 461-0244
Mailing address
7151 HATTERAS LN APT 1D, INDIANAPOLIS, IN 46214-1267
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
05012967A
IN
2255A2300X
Athletic Trainer
36002972A
IN
Other
Enumeration date
02/22/2019
Last updated
08/10/2020
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