Individual
MR. JIM JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
900 W JEFFERSON ST, PLYMOUTH, IN 46563-1634
(574) 936-9600
(574) 936-9612
Mailing address
PO BOX 308, MISHAWAKA, IN 46546-0308
(574) 273-6546
(574) 273-5295
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008652A
IN
Other
Enumeration date
11/15/2005
Last updated
07/08/2007
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