Provider Demographics
NPI:1710466693
Name:JACOBS, TAYLOR J (PT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:J
Other - Last Name:JAHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3505 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2400
Mailing Address - Country:US
Mailing Address - Phone:920-458-2137
Mailing Address - Fax:
Practice Address - Street 1:3505 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2400
Practice Address - Country:US
Practice Address - Phone:920-458-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist