Healthcare Provider Details

I. General information

NPI: 1497687123
Provider Name (Legal Business Name): JAKOB ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19089 FLORIDA BLVD
ALBANY LA
70711-3603
US

IV. Provider business mailing address

18024 MENDOZA HTS
PONCHATOULA LA
70454-4938
US

V. Phone/Fax

Practice location:
  • Phone: 225-209-7140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12380
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: