Individual
MATTHEW JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
788 PRINCE AVE STE C, ATHENS, GA 30606-5912
(706) 543-2111
Mailing address
788 PRINCE AVE STE C, ATHENS, GA 30606-5912
(706) 543-2111
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT014777
GA
2255A2300X
Athletic Trainer
096.004055
IL
Other
Enumeration date
01/04/2016
Last updated
08/20/2020
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