Healthcare Provider Details

I. General information

NPI: 1992589139
Provider Name (Legal Business Name): JACOB SOBECK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 ROBINSON RD STE 1
JACKSON MI
49203-3558
US

IV. Provider business mailing address

3073 SHIRLEY DR
JACKSON MI
49201-7010
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-2540
  • Fax: 517-990-6212
Mailing address:
  • Phone: 517-990-6211
  • Fax: 517-990-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302770
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: