Provider Demographics
NPI:1760717862
Name:JACOBSON, DANIELLE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 S TAMIAMI TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5552
Mailing Address - Country:US
Mailing Address - Phone:941-924-8000
Mailing Address - Fax:941-761-7224
Practice Address - Street 1:7029 S TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5552
Practice Address - Country:US
Practice Address - Phone:941-924-8000
Practice Address - Fax:941-924-8003
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBQ813ZMedicare UPIN