MEDICARE: SYDNEY NALLEY JOBE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1339878	OTHER	TX	PHYSICAL THERAPY LICENSE
2	1339878	OTHER	TX	PHYSICAL THERPY LICENSE

General Provider Information

NPI Number	:	1366047540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY NALLEY JOBE DPT

Provider Business Mailing Address
First Line	:	2518 CARLOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4328
Country	:	US
Telephone Number	:	318-243-7607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 CARLOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4328
Country	:	US
Telephone Number	:	512-215-9272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	11/26/2024

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