Individual
ALEC JAY JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1900 CONVERSE AVE STE B, CHEYENNE, WY 82001-4112
(307) 514-2411
Mailing address
PO BOX 1790, DOUGLAS, WY 82633-1790
(307) 358-9464
(307) 358-9330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1847
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-1847
LICENSE
WY
Enumeration date
04/30/2019
Last updated
04/30/2019
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