Provider Demographics
NPI:1376295600
Name:SARKITOVA, JACOB (DPT, PT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SARKITOVA
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 LAMBERTON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3235
Mailing Address - Country:US
Mailing Address - Phone:810-580-1939
Mailing Address - Fax:
Practice Address - Street 1:140 MECHANIC RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1053
Practice Address - Country:US
Practice Address - Phone:517-439-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301395225100000X
MI5501020181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist