Provider Demographics
NPI:1265464689
Name:JACOBSON, DINELL (PT)
Entity Type:Individual
Prefix:
First Name:DINELL
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 LONGSPUR DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-5313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 W 84TH AVE
Practice Address - Street 2:STE. 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4810
Practice Address - Country:US
Practice Address - Phone:303-426-0967
Practice Address - Fax:303-426-4241
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist