Individual
JACOB WESLEY GROSETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
463688 STATE ROAD 200 STE 9, YULEE, FL 32097-0304
(904) 261-4414
Mailing address
280 EXEMPLA CIR, LAFAYETTE, CO 80026-3370
(303) 338-4545
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT33205
FL
363AS0400X
Surgical Physician Assistant
145866
FL
Other
Enumeration date
11/04/2013
Last updated
12/14/2017
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