MEDICARE: SHEILA RAE JACOBSON PT

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	03185	IA

General Provider Information

NPI Number	:	1700922796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA RAE JACOBSON PT

Provider Business Mailing Address
First Line	:	1028 VALLEY VIEW DR
Second Line	:
City	:	VERMILLION
State	:	SD
Zip	:	57069-3549
Country	:	US
Telephone Number	:	605-624-5690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 VALLEY VIEW DR
Second Line	:
City	:	VERMILLION
State	:	SD
Zip	:	57069-3549
Country	:	US
Telephone Number	:	605-624-5690
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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