Individual
MR. JACK JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT/DPT
Contact information
Practice address
2000 NEWBURG RD, LOUISVILLE, KY 40205-1803
(502) 459-9681
(502) 479-2501
Mailing address
1900 ARBORO PL, LOUISVILLE, KY 40220-3576
(502) 298-4932
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
005251
KY
Other
Enumeration date
04/28/2009
Last updated
04/28/2009
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