Individual
JACOB TRACY GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W AQUA AVE, COEUR D ALENE, ID 83815-7764
(208) 762-1122
Mailing address
2138 W ROUSSEAU DR, COEUR D ALENE, ID 83815-9152
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-8828
ID
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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