Provider Demographics
NPI:1033070271
Name:HANSELL, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:HANSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 FERGUSON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2108
Mailing Address - Country:US
Mailing Address - Phone:619-415-5318
Mailing Address - Fax:
Practice Address - Street 1:1154 E MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7169
Practice Address - Country:US
Practice Address - Phone:619-215-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist