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General NPI Number Information
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NPI Number | 1689962540
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Entity Type | Individual
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Provider Name | KENDAL JACOBSON PT, ATC, LMT
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Gender | Female
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 13800 HUNTERS PASS
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City | AUSTIN
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State | TX
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Zip | 78734-3312
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Country | US
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Telephone | 512-736-6742
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Fax |
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Provider Business Mailing Address
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Address Line | 13800 HUNTERS PASS
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City | AUSTIN
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State | TX
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Zip | 78734-3312
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Country | US
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Telephone | 512-736-6742
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1148826
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1055
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT002723
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License Number State | TX
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