Healthcare Provider Details

I. General information

NPI: 1497388318
Provider Name (Legal Business Name): ZACHARY SCOTT JACOBS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 W GRAND PKWY S
SUGAR LAND TX
77479-4758
US

IV. Provider business mailing address

3706 MAIN POPLAR DR
HOUSTON TX
77025-3122
US

V. Phone/Fax

Practice location:
  • Phone: 281-725-5895
  • Fax: 281-725-5898
Mailing address:
  • Phone: 979-251-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1307961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: