=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538031026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENT ALLEN JACOBSEN CMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2895 CHURN CREEK RD STE D
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-952-8709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3583 BEARWOOD PL
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96007-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-952-8709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 98592
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------