Provider Demographics
NPI:1205847498
Name:JACOBI, MAURIA
Entity Type:Individual
Prefix:MRS
First Name:MAURIA
Middle Name:
Last Name:JACOBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TUTTLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3527
Mailing Address - Country:US
Mailing Address - Phone:203-758-2821
Mailing Address - Fax:
Practice Address - Street 1:22 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1417
Practice Address - Country:US
Practice Address - Phone:203-419-0381
Practice Address - Fax:203-419-0389
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist