Individual
LESLIE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12 INDUSTRIAL PKWY, BRUNSWICK, ME 04011-7314
(207) 729-4998
Mailing address
844 RIVER RD, BRUNSWICK, ME 04011-7112
(207) 725-8953
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1163
LICENSE #
ME
Enumeration date
08/30/2006
Last updated
07/08/2007
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