Individual
JACOB E TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1435 S MAPLE GROVE RD, BOISE, ID 83709-1611
(208) 332-6200
Mailing address
1714 2ND ST N, FARGO, ND 58102-2328
(701) 403-9853
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7512
—
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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