Individual
JACOB GRAVENKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21345 CLEARFIELD CT, BROOKFIELD, WI 53045-3917
(262) 312-0671
Mailing address
21345 CLEARFIELD CT, BROOKFIELD, WI 53045-3917
(262) 312-0671
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
—
—
Other
Enumeration date
04/07/2022
Last updated
04/07/2022
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