Individual
JACOB MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W OTTLEY AVE, FRUITA, CO 81521-2118
(970) 858-3900
Mailing address
300 W OTTLEY AVE, FRUITA, CO 81521-2118
(970) 858-3900
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0014374
CO
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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