Provider Demographics
NPI:1457149254
Name:JACOBS, NICOLE JACQUELINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQUELINE
Last Name:JACOBS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 GYPSY LN APT 10
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1354
Mailing Address - Country:US
Mailing Address - Phone:519-450-9612
Mailing Address - Fax:
Practice Address - Street 1:550 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4024
Practice Address - Country:US
Practice Address - Phone:330-799-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OHPT021648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist