Provider Demographics
NPI:1720027196
Name:JACOBY, KRISTIN DAHL (MS PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAHL
Last Name:JACOBY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 715868
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:804-915-1910
Mailing Address - Fax:
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-282-6338
Practice Address - Fax:804-285-3237
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192301OtherANTHEM PT
VA540885859OtherFOCUS
VA258462OtherSOUTHERN HEALTH
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherCOMPMANAGEMENT
VA540885859OtherCIGNA REHAB
VA540885859OtherVIRGINIA HEALTH NETWORK
VA008908761Medicaid
VA540885859OtherC&O EMPLOYEE'S HEALTHCARE
VA2485613OtherAETNA HMO
VA540885859OtherMULTIPLAN
VA540885859OtherCORVEL
VA98999OtherOPTIMA HEALTH
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA540885859OtherFIRST HEALTH/CCN
VA008908761Medicaid