Provider Demographics
NPI:1508971409
Name:JACOBSEN, CATHERINE MARY (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:MARY
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:26901 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-3806
Mailing Address - Country:US
Mailing Address - Phone:510-331-7912
Mailing Address - Fax:925-676-7897
Practice Address - Street 1:201 VIKING DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1809
Practice Address - Country:US
Practice Address - Phone:510-331-7912
Practice Address - Fax:925-676-7897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer