Provider Demographics
NPI:1932195872
Name:JAKOBSEN, ELISABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:JAKOBSEN
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 1:8186 LARK BROWN RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6434
Mailing Address - Country:US
Mailing Address - Phone:410-730-3399
Mailing Address - Fax:443-478-4726
Practice Address - Street 1:8174 LARK BROWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6426
Practice Address - Country:US
Practice Address - Phone:410-799-9988
Practice Address - Fax:410-799-9986
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18898225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6545-0013OtherBLUE CHOICE
MD7857450OtherAETNA
MD3291921OtherAETNA
MD2107250OtherMAMSI
MD2107250OtherMAMSI