Jacob Frericks, PTA

NPI #1558623835 in Macomb, Illinois

Provider Information

NPI Number: 1558623835
Entity Type: Individual
Name: Jacob Frericks, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Jun 12, 2012
Last Updated: Jun 12, 2012

Practice Location

Address: 130 S LAFAYETTE ST
Address 2: SUITE A
City: Macomb
State: Illinois
ZIP Code: 61455-2289
Phone: (309) 836-2500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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