Provider Demographics
NPI:1831672385
Name:JACOBS, ABBEY LEE (PT)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:LEE
Last Name:JACOBS
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 1:2195 PAXTON DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3647
Mailing Address - Country:US
Mailing Address - Phone:717-503-5028
Mailing Address - Fax:
Practice Address - Street 1:7011 ALLENTOWN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3639
Practice Address - Country:US
Practice Address - Phone:717-909-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist