Provider Demographics
NPI:1801980503
Name:JACOBSON, RHEA (PT)
Entity type:Individual
Prefix:MRS
First Name:RHEA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1724
Mailing Address - Country:US
Mailing Address - Phone:847-568-9192
Mailing Address - Fax:847-568-9193
Practice Address - Street 1:9020 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1724
Practice Address - Country:US
Practice Address - Phone:847-568-9192
Practice Address - Fax:847-568-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001673244OtherBLUE CROSS/ BLUE SHIELD