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NPI Code Detail

MEDICARE: JACOB GROSS

MEDICARE: JACOB GROSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1063138337
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB GROSS
Provider Business Mailing Address
First Line : 79 NORWOOD DR
Second Line :
City : SCIENCE HILL
State : KY
Zip : 42553-9325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 HARMON HTS
Second Line :
City : STANFORD
State : KY
Zip : 40484-1111
Country : US
Telephone Number : 606-369-2141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2022
Last Update Date : 10/18/2022

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Directions to “ JACOB GROSS ” Practice Location

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