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General NPI Number Information
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NPI Number | 1588558720
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Entity Type | Individual
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Provider Name | JACOB NEATHERTON DPT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 8073 WASHINGTON VILLAGE DR STE 110
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City | DAYTON
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State | OH
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Zip | 45458-1967
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Country | US
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Telephone | 937-938-8380
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Fax | 937-938-8392
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Provider Business Mailing Address
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Address Line | 6480 HARRISON AVE STE 201
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City | CINCINNATI
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State | OH
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Zip | 45247-7961
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Country | US
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Telephone | 513-818-0043
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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 | PT021701
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License Number State | OH
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