Individual
JACOB PENROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT, CWS
Contact information
Practice address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8535
Mailing address
577 E 620 N, SMITHFIELD, UT 84335-6734
(435) 938-8504
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8076772-2401
UT
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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