Provider Demographics
NPI:1790425379
Name:HARP, JACOB (ACSM-EP)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:HARP
Suffix:
Gender:M
Credentials:ACSM-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13380 CLARKSVILLE PIKE
Mailing Address - Street 2:SUITE I (BOX 8)
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9725
Mailing Address - Country:US
Mailing Address - Phone:210-705-3177
Mailing Address - Fax:
Practice Address - Street 1:13380 CLARKSVILLE PIKE STE I
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777-9725
Practice Address - Country:US
Practice Address - Phone:443-718-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1035075224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist