Individual
JOHN VINCENT JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6722 HIGHWAY 50, LAKE GENEVA, WI 53147-3647
(262) 248-2029
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 444-6350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1515-019
WI
Other
Enumeration date
02/09/2009
Last updated
08/18/2014
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