Individual
JILL JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1495 NORTHSIDE DR NW STE A, ATLANTA, GA 30318-4200
(470) 823-2030
(470) 823-2031
Mailing address
33900 HARPER AVE STE 104, CLINTON TOWNSHIP, MI 48035-4258
(586) 350-2644
(586) 541-3735
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002759
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA002759
STATE LISC NUMBER
GA
Enumeration date
11/06/2006
Last updated
01/16/2024
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