Individual
JESSICA J KOTNOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
120 W PEARL AVE, JACKSON, WY 83001-8657
(307) 734-1929
(307) 734-1427
Mailing address
PO BOX 8857, JACKSON, WY 83002-8857
(307) 734-1929
(307) 734-1427
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1579
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT1579
WYOMING LICENSE
WY
Enumeration date
07/14/2015
Last updated
07/14/2015
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