# FREEFORM WELLNESS PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1689185803
- **Authorized official:** DR. JESSE JACOBS (OWNER)
- **Authorized official phone:** (817) 431-5100

## Contact information

- **Practice address:** 4525 HERITAGE TRACE PKWY STE 101, FORT WORTH, TX 76244-8908
- **Practice address phone:** (817) 431-5100
- **Mailing address:** 4525 HERITAGE TRACE PKWY STE 101, FORT WORTH, TX 76244-8908
- **Mailing address phone:** (817) 431-5100

## Taxonomy

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

## Other

- **Enumeration date:** 10/15/2017
- **Last updated:** 10/15/2017