Provider Demographics
NPI:1912015157
Name:JACOBS, ROBB DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:ROBB
Middle Name:DOUGLAS
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:4701 41ST AVE SW
Practice Address - Street 2:STE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4597
Practice Address - Country:US
Practice Address - Phone:206-932-8363
Practice Address - Fax:206-932-4973
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000010209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0212044OtherWASHINGTON L&I
WA8460420Medicaid
WAP00815587OtherRR MEDICARE
WA1912015157Medicaid
WA1912015157Medicaid
WA0212044OtherWASHINGTON L&I