Provider Demographics
NPI:1932671237
Name:CHEEK, JACOB CHARLES (PTA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CHARLES
Last Name:CHEEK
Suffix:
Gender:M
Credentials:PTA
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 41
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-0041
Mailing Address - Country:US
Mailing Address - Phone:606-594-0636
Mailing Address - Fax:
Practice Address - Street 1:1033 N HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-5478
Practice Address - Country:US
Practice Address - Phone:606-598-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03662225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant