Individual
MRS. MARY BETH JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
E11016A GROTH RD, NORTH FREEDOM, WI 53951-9727
(608) 644-9082
Mailing address
E11016A GROTH RD, NORTH FREEDOM, WI 53951-9727
(608) 644-9082
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
#681-019
WI
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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