Healthcare Provider Details

I. General information

NPI: 1942124508
Provider Name (Legal Business Name): JACOB DE BEER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8917 W COLONIAL DR
OCOEE FL
34761-6955
US

IV. Provider business mailing address

12065 REBECCAS RUN DR
WINTER GARDEN FL
34787-5527
US

V. Phone/Fax

Practice location:
  • Phone: 407-748-8630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: