Provider Demographics
NPI:1851953160
Name:JACOBS, SHEILA DIANE (MPT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2965 E TARPON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9007
Mailing Address - Country:US
Mailing Address - Phone:208-287-9420
Mailing Address - Fax:208-287-9426
Practice Address - Street 1:1255 N ALLEN AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2208
Practice Address - Country:US
Practice Address - Phone:208-297-5676
Practice Address - Fax:208-416-6635
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist