Individual
MRS. AMY LYNN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
7000 54TH ST, KENOSHA, WI 53144-3751
(712) 540-7418
Mailing address
7000 54TH ST, KENOSHA, WI 53144-3751
(712) 540-7418
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11412-24
WI
Other
Enumeration date
07/23/2010
Last updated
10/16/2012
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