MEDICARE: MR. ALAN JACOBS P.T.

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
1	225100000X	Physical Therapist	40QA00593600	NJ

General Provider Information

NPI Number	:	1386723294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN JACOBS P.T.

Provider Business Mailing Address
First Line	:	16 SURF AVE
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-2105
Country	:	US
Telephone Number	:	732-869-0750
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 GLOBE CT
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1824
Country	:	US
Telephone Number	:	732-345-1377
Fax Number	:	732-936-9493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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