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1497259055
JIBU JACOB
WATERFORD, MI
NPI
1497259055
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
261QP2000X Clinic/Center, Physical Therapy
(Licence: MI 5501014216)
Enumeration Date
2018-03-20
Last Update Date
2018-03-20
Business Address
JIBU JACOB
1901 N TELEGRAPH RD
WATERFORD, MI 48328-1878
Phone number: 248-836-1000
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Mailing Address
JIBU JACOB
42265 ARCADIA DR
STERLING HEIGHTS, MI 48313-2605
Phone number: 586-218-0225
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