Provider Demographics
NPI:1992205314
Name:JACOBS, SEAN EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:EDWARD
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 1:2829 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1261
Mailing Address - Country:US
Mailing Address - Phone:803-851-3506
Mailing Address - Fax:803-619-9551
Practice Address - Street 1:2829 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1261
Practice Address - Country:US
Practice Address - Phone:803-851-3506
Practice Address - Fax:803-619-9551
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist