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General NPI Number Information
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NPI Number | 1760557003
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Entity Type | Individual
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Provider Name | THOMAS JACOBSON LMT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8 ALTON PL SUITE 2A
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City | BROOKLINE
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State | MA
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Zip | 02446-6447
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Country | US
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Telephone | 617-739-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 56 ROBESON ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2916
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Country | US
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Telephone | 617-524-5141
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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