Provider Demographics
NPI:1235605387
Name:HILDEBRANDT, JAKOB CORNELIUS
Entity Type:Individual
Prefix:
First Name:JAKOB
Middle Name:CORNELIUS
Last Name:HILDEBRANDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 2ND AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1137
Mailing Address - Country:US
Mailing Address - Phone:781-487-3800
Mailing Address - Fax:781-487-3801
Practice Address - Street 1:40 2ND AVE STE 360
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1137
Practice Address - Country:US
Practice Address - Phone:781-487-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist