# JACOB EGBERT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083236301
- **Authorized official:** JACOB R EGBERT DO (OWNER/ DO)
- **Authorized official phone:** (435) 938-8657

## Contact information

- **Practice address:** 8074 S 1300 E, SANDY, UT 84094-0743
- **Practice address phone:** (801) 561-3400
- **Mailing address:** 274 N MAIN ST, LOGAN, UT 84321-3915
- **Mailing address phone:** (435) 753-1600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2020
- **Last updated:** 05/08/2020