Provider Demographics
NPI:1396178588
Name:THURMANN, JACOB TODD (PT)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TODD
Last Name:THURMANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 S 2ND ST STE B100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7015
Mailing Address - Country:US
Mailing Address - Phone:512-447-9675
Mailing Address - Fax:512-428-9675
Practice Address - Street 1:3809 S 2ND ST STE B100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7015
Practice Address - Country:US
Practice Address - Phone:512-447-9675
Practice Address - Fax:512-428-9675
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14571556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist