Healthcare Provider Details

I. General information

NPI: 1295327096
Provider Name (Legal Business Name): CURTIS LESLIE JACOBSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 PLEASANT COUNTRY LN
RIGBY ID
83442-5278
US

IV. Provider business mailing address

1411 FALLS AVE E STE 401
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-228-9959
  • Fax: 208-297-7010
Mailing address:
  • Phone: 208-228-9959
  • Fax: 208-297-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT-1675
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1675
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: