Provider Demographics
NPI:1003300708
Name:FLINT, JACOB C (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:FLINT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2666
Mailing Address - Country:US
Mailing Address - Phone:706-367-1898
Mailing Address - Fax:706-367-1899
Practice Address - Street 1:1660 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2666
Practice Address - Country:US
Practice Address - Phone:706-367-1898
Practice Address - Fax:706-367-1899
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist