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NPI Code Detail

MEDICARE: MR. JOSEF BEETHOVEN JACOBSON D.P.T.

MEDICARE: MR. JOSEF BEETHOVEN JACOBSON D.P.T.
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
1225100000XPhysical Therapist4792SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750322400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEF BEETHOVEN JACOBSON D.P.T.
Provider Business Mailing Address
First Line : 350 AUSTIN GRAYBILL RD
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29860-9251
Country : US
Telephone Number : 803-278-4272
Fax Number : 803-278-1794
Provider Business Practice Location Address
First Line : 350 AUSTIN GRAYBILL RD
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29860-9251
Country : US
Telephone Number : 803-278-4272
Fax Number : 803-278-1794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 07/09/2007

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