Michael Gene Jacketta, MPT, OCS

NPI #1134131055 in Evanston, Wyoming

Provider Information

NPI Number
1134131055
Entity Type
Individual
Name
Michael Gene Jacketta, MPT, OCS
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Physical Therapist
Credential
MPT, OCS
Enumeration Date
Aug 12, 2006
Last Updated
Jul 8, 2007

Practice Location

Address
620 WEST CHEYENNE DRIVE
State
Wyoming
ZIP Code
82930-5359
Phone
(307) 789-8860

Specialties & Taxonomy Codes

Specialty
Physical Therapist

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