Provider Demographics
NPI:1679745111
Name:JACOBSON, KIMBERLY FAENZI (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:FAENZI
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 LAKEVILLE XING
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8206
Mailing Address - Country:US
Mailing Address - Phone:317-370-0988
Mailing Address - Fax:
Practice Address - Street 1:16620 LAKEVILLE XING
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8206
Practice Address - Country:US
Practice Address - Phone:317-370-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009296A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist