Provider Demographics
NPI:1346809696
Name:HONEA, JACOB (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HONEA
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 1:8304 GRINDER CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2743
Mailing Address - Country:US
Mailing Address - Phone:931-247-3407
Mailing Address - Fax:
Practice Address - Street 1:313 MANUFACTURERS RD # C215
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3274
Practice Address - Country:US
Practice Address - Phone:423-254-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist