MEDICARE: MRS. BRIDGET RANAE JACOBS-HOLMES RPT

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	2251P0200X	Pediatric Physical Therapist	11421	MA
2	2251G0304X	Geriatric Physical Therapist	11421	MA

General Provider Information

NPI Number	:	1831184571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIDGET RANAE JACOBS-HOLMES RPT

Provider Business Mailing Address
First Line	:	3 WOODLAND RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-2120
Country	:	US
Telephone Number	:	413-455-1697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WOODLAND RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-2120
Country	:	US
Telephone Number	:	413-455-1697
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/07/2010

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