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NPI Code Detail

MEDICARE: JACOB E GROSS PT

MEDICARE: JACOB E GROSS PT
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 TherapistPT299009CA

General Provider Information

NPI Number : 1629667191
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB E GROSS PT
Provider Business Mailing Address
First Line : 607 LIBERTY ST
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-3131
Country : US
Telephone Number : 510-333-5872
Fax Number :
Provider Business Practice Location Address
First Line : 1050 SAN MIGUEL RD
Second Line :
City : CONCORD
State : CA
Zip : 94518-2094
Country : US
Telephone Number : 925-825-4280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2021
Last Update Date : 01/11/2021

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