Provider Demographics
NPI:1265900948
Name:JACOBS, ANGELINA SAUDIA (LMT)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:SAUDIA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WISCONSIN AVE NW APT 519
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5014
Mailing Address - Country:US
Mailing Address - Phone:202-277-2327
Mailing Address - Fax:
Practice Address - Street 1:3130 WISCONSIN AVE NW APT 519
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5014
Practice Address - Country:US
Practice Address - Phone:202-277-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT0508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist