MEDICARE: RHONDA LYNN JACOBSON

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	225200000X	Physical Therapy Assistant	14-01899	KS
2	225200000X	Physical Therapy Assistant	2010019648	MO

General Provider Information

NPI Number	:	1639488737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA LYNN JACOBSON

Provider Business Mailing Address
First Line	:	925 S SEMORAN BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5313
Country	:	US
Telephone Number	:	407-277-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 S SEMORAN BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5313
Country	:	US
Telephone Number	:	407-277-2067
Fax Number	:

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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Directions to “ RHONDA LYNN JACOBSON ” Practice Location

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