Provider Demographics
NPI:1598642985
Name:ROONEY, JACOB TYLER (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:TYLER
Last Name:ROONEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BOSTON POST RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2733
Mailing Address - Country:US
Mailing Address - Phone:203-458-1645
Mailing Address - Fax:203-458-1689
Practice Address - Street 1:705 BOSTON POST RD STE 5A
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2733
Practice Address - Country:US
Practice Address - Phone:203-458-1645
Practice Address - Fax:203-458-1689
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist