Individual ProviderJacob David MillerPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address700 West Ave S, La Crosse, WI 54601-4783(608) 785-0940PECOS EnrollmentBased on the most recent information from CMS, provider Jacob David Miller does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1619647062Provider TypeIndividualFull NameMiller, Jacob DavidGenderMaleSole ProprietorNoEnumeration Date9/16/2021Last Updated6/28/2024Contact InformationPractice LocationPractice Address700 West Ave S, La Crosse, WI 54601-4783Phone(608) 785-0940FaxUnlisted FaxMailing LocationMailing Address200 1st St SW, Rochester, MN 55905-0001PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense15624WisconsinCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense12235Minnesota