Individual
JAIME JACOBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4720 23RD AVE, MISSOULA, MT 59803-1137
(406) 251-5100
Mailing address
4718 23RD AVE, SUITE 500, MISSOULA, MT 59803-1163
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTP-PTA-LIC-7687
MT
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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