Idaho
Division of Occupational and Professional Licenses
JACOB ELIAS BLACK
Physical Therapy Licensure Board - Physical Therapist
License number
PT - 3728
Date granted
07/29/2014
Date expires
09/04/2016
Class
Physical Therapy Licensure Board - Physical Therapist
Status
Current
Address
FRUITLAND ID 83619
idaholicensing.com
ID 43730526
LAST UPDATED 2024-04-05 02:30:07 UTC
LAST UPDATED 2024-04-05 02:30:07 UTC
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