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General NPI Number Information
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NPI Number | 1548908130
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Entity Type | Individual
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Provider Name | ERICA E JACOBSON MAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3609 SW DURHAM DR
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City | DURHAM
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State | NC
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Zip | 27707-6507
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Country | US
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Telephone | 919-403-5180
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Fax | 919-477-1929
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Provider Business Mailing Address
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Address Line | 3609 SW DURHAM DR
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City | DURHAM
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State | NC
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Zip | 27707-6507
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Country | US
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Telephone | 919-403-5180
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | LAT-5827
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | LAT-5827
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-5827
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License Number State | NC
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