Provider Demographics
NPI:1023782240
Name:JACQUES, ERIC ALAN (DPT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:JACQUES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2014
Mailing Address - Country:US
Mailing Address - Phone:207-649-9203
Mailing Address - Fax:
Practice Address - Street 1:2217 SUNSET BLVD STE 711
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4783
Practice Address - Country:US
Practice Address - Phone:916-435-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist