Provider Demographics
NPI:1790904712
Name:JACOBSON, CYNTHIA DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
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 1:10262 KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8059
Mailing Address - Country:US
Mailing Address - Phone:303-470-3207
Mailing Address - Fax:303-471-4133
Practice Address - Street 1:10262 KNOLL CIR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-8059
Practice Address - Country:US
Practice Address - Phone:303-470-3207
Practice Address - Fax:303-471-4133
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist