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NPI Code Detail

MEDICARE: NICOLE M JACOBSON DPT

MEDICARE: NICOLE M JACOBSON DPT
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
1225100000XPhysical Therapist12394AZ

General Provider Information

NPI Number : 1386197622
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE M JACOBSON DPT
Provider Business Mailing Address
First Line : PO BOX 80217
Second Line :
City : PHOENIX
State : AZ
Zip : 85060-0217
Country : US
Telephone Number : 602-385-2115
Fax Number : 480-418-3323
Provider Business Practice Location Address
First Line : 40601 N GANTZEL RD STE 103
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-7036
Country : US
Telephone Number : 602-648-5444
Fax Number : 602-772-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2016
Last Update Date : 07/25/2022

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Directions to “ NICOLE M JACOBSON DPT” Practice Location

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