Provider Demographics
NPI:1215110119
Name:JACOBS-EL, NAOMI (LMT, RYT, CPT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:JACOBS-EL
Suffix:
Gender:F
Credentials:LMT, RYT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 2ND AVE N APT 101
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-2040
Mailing Address - Country:US
Mailing Address - Phone:256-653-8280
Mailing Address - Fax:
Practice Address - Street 1:4072 SULLIVAN ST STE G
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3153
Practice Address - Country:US
Practice Address - Phone:256-653-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AL2305172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT291247Medicare PIN