Jacob Louis Durham, PTA

NPI #1740024223 in Jackson, Wyoming

Provider Information

NPI Number: 1740024223
Entity Type: Individual
Name: Jacob Louis Durham, PTA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Jun 20, 2024
Last Updated: Jun 20, 2024

Practice Location

Address: 555 E BROADWAY AVE STE 100
City: Jackson
State: Wyoming
ZIP Code: 83001-8640
Phone: (307) 739-7491

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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