Provider Demographics
NPI:1588813448
Name:JACOBSEN, TINEKE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TINEKE
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N GATE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4622
Mailing Address - Country:US
Mailing Address - Phone:925-945-7830
Mailing Address - Fax:925-945-0709
Practice Address - Street 1:60 DOLORES WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-4108
Practice Address - Country:US
Practice Address - Phone:925-377-0174
Practice Address - Fax:925-377-0174
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist