Provider Demographics
NPI:1518734425
Name:RICHINS, JACOB STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:STEVEN
Last Name:RICHINS
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 1:1411 FALLS AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-738-4440
Mailing Address - Fax:208-801-6859
Practice Address - Street 1:98 HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:FILER
Practice Address - State:ID
Practice Address - Zip Code:83328-9602
Practice Address - Country:US
Practice Address - Phone:208-738-4440
Practice Address - Fax:208-801-6859
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist