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General NPI Number Information
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NPI Number | 1760100184
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Entity Type | Individual
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Provider Name | JACOB FERRIS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 277 BOARDMAN CANFIELD RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4806
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Country | US
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Telephone | 330-726-9671
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Fax |
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Provider Business Mailing Address
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Address Line | 79 WOODVIEW AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4646
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Country | US
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Telephone | 330-314-3391
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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 | PT020072
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License Number State | OH
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