Provider Demographics
NPI:1265693998
Name:JACOBS, REBECCA (CCMT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2127
Mailing Address - Country:US
Mailing Address - Phone:269-506-2891
Mailing Address - Fax:
Practice Address - Street 1:414 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2127
Practice Address - Country:US
Practice Address - Phone:269-506-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist