Provider Demographics
NPI:1831981869
Name:JACOBS, LEO SAMUEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:SAMUEL
Last Name:JACOBS
Suffix:
Gender:M
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 1:7912 DANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35619-6476
Mailing Address - Country:US
Mailing Address - Phone:256-612-7828
Mailing Address - Fax:
Practice Address - Street 1:2232 N CLYBOURN AVE FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3193
Practice Address - Country:US
Practice Address - Phone:773-377-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.029080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist