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General NPI Number Information
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NPI Number | 1104668581
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Entity Type | Individual
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Provider Name | COURTNEY JACOBSEN PT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1412 A AVE W STE A
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City | OSKALOOSA
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State | IA
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Zip | 52577-1970
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Country | US
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Telephone | 641-676-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 E 17TH ST S
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City | NEWTON
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State | IA
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Zip | 50208-5000
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Country | US
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Telephone | 641-521-4839
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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 | 124779
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License Number State | IA
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