Individual
ASHLEY MAYCOCK JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
126 AVOCADO AVE, SUITE 107, PERRIS, CA 92571-2605
(951) 943-8105
(951) 943-8106
Mailing address
24630 WASHINGTON AVE, SUITE 200, MURRIETA, CA 92562-6177
(951) 696-9353
(951) 973-7216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
36670
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12245961
CAQH PROVIDER ID
CA
Enumeration date
02/09/2011
Last updated
03/31/2014
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