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NPI Code Detail

MEDICARE: LINDSEY JACOBSON PTA

MEDICARE: LINDSEY JACOBSON PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant160004616IL

General Provider Information

NPI Number : 1013189414
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDSEY JACOBSON PTA
Provider Business Mailing Address
First Line : PO BOX 2176
Second Line : DEPT 5389
City : MILWAUKEE
State : WI
Zip : 53201-2176
Country : US
Telephone Number : 815-713-2600
Fax Number : 815-654-8020
Provider Business Practice Location Address
First Line : 3475 S ALPINE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61109-2604
Country : US
Telephone Number : 815-874-8000
Fax Number : 815-874-7525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2008
Last Update Date : 01/07/2010

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Directions to “ LINDSEY JACOBSON PTA” Practice Location

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