Provider Demographics
NPI:1245039833
Name:SACKS, JACOB ALEXANDER (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALEXANDER
Last Name:SACKS
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 1:2212 BARONS WAY CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7113
Mailing Address - Country:US
Mailing Address - Phone:636-236-9942
Mailing Address - Fax:636-236-9942
Practice Address - Street 1:8449 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9662
Practice Address - Country:US
Practice Address - Phone:636-236-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist