Provider Demographics
NPI:1205129921
Name:MCPHERSON, JACOB (PT, DPT, NCS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1524
Mailing Address - Country:US
Mailing Address - Phone:716-690-2051
Mailing Address - Fax:716-690-2160
Practice Address - Street 1:3940 CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2275
Practice Address - Country:US
Practice Address - Phone:716-662-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338202251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology