Organization
FREEFORM WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE JACOBS (OWNER)
(817) 431-5100
Entity
Organization
Contact information
Practice address
4525 HERITAGE TRACE PKWY STE 101, FORT WORTH, TX 76244-8908
(817) 431-5100
Mailing address
4525 HERITAGE TRACE PKWY STE 101, FORT WORTH, TX 76244-8908
(817) 431-5100
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
10/15/2017
Last updated
10/15/2017
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