Provider Demographics
NPI:1255572376
Name:JACOBSON, ERIN TEAL (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TEAL
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:TEAL
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3010 FARROW RD
Mailing Address - Street 2:STE 120
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-7607
Mailing Address - Country:US
Mailing Address - Phone:803-434-7750
Mailing Address - Fax:803-434-2983
Practice Address - Street 1:3010 FARROW RD
Practice Address - Street 2:STE 120
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7607
Practice Address - Country:US
Practice Address - Phone:803-434-7750
Practice Address - Fax:803-434-2983
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist