Healthcare Provider Details

I. General information

NPI: 1396689618
Provider Name (Legal Business Name): CALE JACOBS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GOODWIN DR
FOXBOROUGH MA
02035-4203
US

IV. Provider business mailing address

10 GOODWIN DR
FOXBOROUGH MA
02035-4203
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-8197
  • Fax:
Mailing address:
  • Phone: 859-797-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: