Individual
JACOB BRAD SOUVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2615 NAKOTA RD, ROYAL OAK, MI 48073-1816
(586) 210-0530
Mailing address
71575 JULIUS DR, BRUCE TOWNSHIP, MI 48065-3187
(586) 569-1621
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501301913
MI
Other
Enumeration date
06/02/2022
Last updated
05/08/2024
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