Provider Demographics
NPI:1922141142
Name:JACOBS, SARAH (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
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:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-0579
Mailing Address - Country:US
Mailing Address - Phone:724-543-8880
Mailing Address - Fax:724-543-8788
Practice Address - Street 1:1 NOLTE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:724-543-8880
Practice Address - Fax:724-543-8788
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT014322OtherPA STATE LICENSE NUMBER