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General NPI Number Information
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NPI Number | 1851030704
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Entity Type | Individual
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Provider Name | JACOB ROBERT GRABOSKI DPT
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Gender | Male
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 2275 RILEY RD STE 3
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City | SPARTA
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State | WI
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Zip | 54656-1579
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Country | US
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Telephone | 715-252-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 810 WESTWOOD DR
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City | ONALASKA
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State | WI
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Zip | 54650-2140
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Country | US
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Telephone | 715-252-8520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15006-24
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License Number State | WI
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