Individual
SAMANTHA ROSE JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
305 S CLARK ST, MAYVILLE, WI 53050-1488
(920) 387-0354
Mailing address
5580 JACQUELINE DR, WEST BEND, WI 53095-9728
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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