Individual
JACOB DALTON PISTOL MILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
21576 S ELLSWORTH LOOP RD STE 108, QUEEN CREEK, AZ 85142-1068
(602) 737-2275
Mailing address
552 W LOVE RD, SAN TAN VALLEY, AZ 85143-4808
(480) 694-2245
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014294
AZ
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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