Individual
JACOB LOUIS DURHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
555 E BROADWAY AVE STE 100, JACKSON, WY 83001-8640
(307) 739-7491
Mailing address
555 E BROADWAY AVE STE 100, JACKSON, WY 83001-8640
(307) 739-7491
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1135
WY
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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