Provider Demographics
NPI:1255717773
Name:JACOB, JENNIE
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:THERAPY SERVICES
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-694-6341
Mailing Address - Fax:
Practice Address - Street 1:535 N WILMOT RD
Practice Address - Street 2:CHILDREN'S MULTISPECIALTY CENTER: NEWBORN FOLLOW UP
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2600
Practice Address - Country:US
Practice Address - Phone:520-694-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics