MEDICARE: DR. SARAH R JACOBSON DPT

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	070.017179	IL

General Provider Information

NPI Number	:	1942529169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH R JACOBSON DPT

Provider Business Mailing Address
First Line	:	1030 W GEORGE ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4385
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 W 95TH STREET
Second Line	:
City	:	OAKLAWN
State	:	IL
Zip	:	60453
Country	:	US
Telephone Number	:	708-684-5425
Fax Number	:

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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