Provider Demographics
NPI:1578810321
Name:JACOBS, DINAH F (DPT)
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:F
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DINAH
Other - Middle Name:H
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:1312 W ARCH HAVEN AVE STE E
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2088
Practice Address - Country:US
Practice Address - Phone:812-336-8406
Practice Address - Fax:812-336-8342
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60304424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8912080Medicare PIN