Provider Demographics
NPI:1669747127
Name:JACOBS, JOSEPH (DPT, ASTRS, ACN)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DPT, ASTRS, ACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26895 ALISO CREEK RD
Mailing Address - Street 2:STE B270
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-727-2192
Mailing Address - Fax:949-727-2193
Practice Address - Street 1:26895 ALISO CREEK RD
Practice Address - Street 2:STE B270
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5301
Practice Address - Country:US
Practice Address - Phone:888-210-2787
Practice Address - Fax:949-236-6862
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA38861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY561ZOtherMEDICARE PTAN