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General NPI Number Information
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NPI Number | 1093065336
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Entity Type | Individual
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Provider Name | BRIAN EDWIN JACOBSON PT
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Gender | Male
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 500 PASEO CAMARILLO SUITE 105
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City | CAMARILLO
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State | CA
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Zip | 93010-5900
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Country | US
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Telephone | 805-987-6851
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Fax |
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Provider Business Mailing Address
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Address Line | 132 CINDY AVE
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City | NEWBURY PARK
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State | CA
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Zip | 91320-4421
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Country | US
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Telephone | 951-660-1259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 39343
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License Number State | CA
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