Individual
JACOB LEVI MONTANA SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1609 PALOMINO DR, LARAMIE, WY 82070-5393
(307) 299-0131
Mailing address
1609 PALOMINO DR, LARAMIE, WY 82070-5393
(307) 299-0131
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-0860
WY
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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