Provider Demographics
NPI:1689033599
Name:JACOBS, JAMIE (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 APEX DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1282
Mailing Address - Country:US
Mailing Address - Phone:618-441-0482
Mailing Address - Fax:618-441-0482
Practice Address - Street 1:2611 S BANKER ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2980
Practice Address - Country:US
Practice Address - Phone:217-280-4550
Practice Address - Fax:217-280-4551
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist