Provider Demographics
NPI:1942456744
Name:JACOBO, MARIA ISABEL A (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA ISABEL
Middle Name:A
Last Name:JACOBO
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 1:701 N FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2037
Mailing Address - Country:US
Mailing Address - Phone:650-793-6331
Mailing Address - Fax:
Practice Address - Street 1:701 N FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2037
Practice Address - Country:US
Practice Address - Phone:650-793-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist