Individual
SCOTT L JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
811 E LE CLAIRE RD, ELDRIDGE, IA 52748-1733
(563) 285-2174
(563) 285-5510
Mailing address
3385 DEXTER CT, SUITE 301, DAVENPORT, IA 52807-3494
(563) 344-6645
(563) 441-7796
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02168
IA
225100000X
Physical Therapist
070005974
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0221002
—
IA
Enumeration date
10/03/2005
Last updated
07/17/2012
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