Individual
MS. KIMBERLY ANN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
118 E WALTANN LN, PHOENIX, AZ 85022-3037
(602) 692-7232
Mailing address
118 E WALTANN LN, PHOENIX, AZ 85022-3037
(602) 692-7232
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1389
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
356388
AHCCCS
AZ
Enumeration date
08/23/2010
Last updated
08/23/2010
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