Provider Demographics
NPI:1013187533
Name:MCBRIDE, JACOB CHRISTOPHER (MPT)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:CHRISTOPHER
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 S MAIN STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-488-2322
Mailing Address - Fax:716-488-2574
Practice Address - Street 1:15 S MAIN STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-488-2322
Practice Address - Fax:716-488-2574
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT019119225100000X
NY032656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist