Provider Demographics
NPI:1184177107
Name:JACOBOWITZ, SILVIA R (PTA)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:R
Last Name:JACOBOWITZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MICHAEL RD
Mailing Address - Street 2:APT A
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2432
Mailing Address - Country:US
Mailing Address - Phone:860-857-2173
Mailing Address - Fax:
Practice Address - Street 1:87 MICHAEL RD
Practice Address - Street 2:APT A
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2432
Practice Address - Country:US
Practice Address - Phone:860-857-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1713225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant