Provider Demographics
NPI:1689962540
Name:JACOBSON, KENDAL (PT, ATC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:KENDAL
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PT, ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 HUNTERS PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3312
Mailing Address - Country:US
Mailing Address - Phone:512-736-6742
Mailing Address - Fax:
Practice Address - Street 1:13800 HUNTERS PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-3312
Practice Address - Country:US
Practice Address - Phone:512-736-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11488262251X0800X
TXAT10552255A2300X
TXMT002723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer