Individual
JACOB REIS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10355 N LA CANADA DR STE 125, ORO VALLEY, AZ 85737-7307
(520) 822-8640
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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