Individual
JACOB POLLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Mailing address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160009121
STATE LICENSE
IL
Enumeration date
01/26/2021
Last updated
01/26/2021
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