Individual
MR. MATTHEW JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8700
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8700
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1624
ND
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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