Provider Demographics
NPI:1265561500
Name:JACOBSON, JAMES R (P T)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-8130
Mailing Address - Country:US
Mailing Address - Phone:814-378-5603
Mailing Address - Fax:
Practice Address - Street 1:61 6TH ST
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651-8130
Practice Address - Country:US
Practice Address - Phone:814-378-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002913L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001885964 0001OtherPROVIDER NUMBER