MEDICARE: MR. DANIEL STEVEN JACOBSON 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
1	225100000X	Physical Therapist	5501004892	MI

General Provider Information

NPI Number	:	1750492211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL STEVEN JACOBSON P.T.

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	29480 WOODWARD AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-0903
Country	:	US
Telephone Number	:	248-541-8386
Fax Number	:	248-541-8386

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/06/2022

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