Provider Demographics
NPI:1679212302
Name:JACOBS, GRANT CHARLES (DPT)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:CHARLES
Last Name:JACOBS
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 1:110 BAUGHMANS LN STE 160
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4946
Mailing Address - Country:US
Mailing Address - Phone:240-651-1335
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN STE 160
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4946
Practice Address - Country:US
Practice Address - Phone:240-651-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist