Provider Demographics
NPI:1558429969
Name:JACOB, JEFFREY JOHN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:JACOB
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 1:4053 S LAPEER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8721
Mailing Address - Country:US
Mailing Address - Phone:810-441-3033
Mailing Address - Fax:810-678-3205
Practice Address - Street 1:4053 S LAPEER RD
Practice Address - Street 2:SUITE C
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8721
Practice Address - Country:US
Practice Address - Phone:810-441-3033
Practice Address - Fax:810-678-3936
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist