Provider Demographics
NPI:1700911849
Name:JACOBS, MARGUERITE CECILE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:CECILE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 CAVAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3420
Mailing Address - Country:US
Mailing Address - Phone:314-302-9011
Mailing Address - Fax:314-427-3937
Practice Address - Street 1:3334 CAVAN DR
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3420
Practice Address - Country:US
Practice Address - Phone:314-302-9011
Practice Address - Fax:314-427-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist