Provider Demographics
NPI:1457025124
Name:JUSTICE, JACOB SIMS (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SIMS
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2823 GREYSTONE COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2660
Mailing Address - Country:US
Mailing Address - Phone:205-745-3660
Mailing Address - Fax:
Practice Address - Street 1:125 STEPHEN J WHITE MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2106
Practice Address - Country:US
Practice Address - Phone:256-315-9693
Practice Address - Fax:256-315-9694
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH10467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist