Provider Demographics
NPI:1114516713
Name:KROON, JACOB THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:KROON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2058
Mailing Address - Country:US
Mailing Address - Phone:615-391-4545
Mailing Address - Fax:
Practice Address - Street 1:5651 FRIST BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2058
Practice Address - Country:US
Practice Address - Phone:615-391-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist