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General NPI Number Information
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NPI Number | 1457149254
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Entity Type | Individual
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Provider Name | NICOLE JACQUELINE JACOBS
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 550 S CANFIELD NILES RD
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City | AUSTINTOWN
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State | OH
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Zip | 44515-4024
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Country | US
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Telephone | 330-799-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 461 GYPSY LN APT 10
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-1354
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Country | US
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Telephone | 519-450-9612
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT021648
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License Number State | OH
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