Provider Demographics
NPI:1770753022
Name:JACOBS, JEANNE (PT, PA-C)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PT, PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:104 QUARRY STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7564
Mailing Address - Country:US
Mailing Address - Phone:617-770-4167
Mailing Address - Fax:617-770-0971
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-770-4167
Practice Address - Fax:617-770-0971
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA181462251X0800X
MAPA4272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic