Individual
JACOB FRERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
130 S LAFAYETTE ST, SUITE A, MACOMB, IL 61455-2289
(309) 836-2500
Mailing address
135 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 661-8823
(309) 661-8801
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005557
IL
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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