Individual
JACOB TEIXEIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 TER HEUN DR, FALMOUTH, MA 02540-2503
(508) 548-5300
Mailing address
2575 COUNTY ST, DIGHTON, MA 02715-1606
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
PA9070
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000029219
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
Enumeration date
08/05/2017
Last updated
10/26/2022
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