Provider Demographics
NPI:1770527939
Name:JACOBSON, RANDY F (PT)
Entity type:Individual
Prefix:MS
First Name:RANDY
Middle Name:F
Last Name:JACOBSON
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Gender:F
Credentials:PT
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Mailing Address - Street 1:2901 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4901
Mailing Address - Country:US
Mailing Address - Phone:310-582-1190
Mailing Address - Fax:310-582-1165
Practice Address - Street 1:2901 WILSHIRE BLVD
Practice Address - Street 2:SUITE 319
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4901
Practice Address - Country:US
Practice Address - Phone:310-582-1190
Practice Address - Fax:310-582-1165
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT98312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics