Provider Demographics
NPI:1215110119
Name:JACOBS-EL, NAOMI (DPT, LMT, RYT, CPT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:JACOBS-EL
Suffix:
Gender:F
Credentials:DPT, 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 1:1902A LINCOLN BLVD # 108
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1315
Mailing Address - Country:US
Mailing Address - Phone:256-653-8280
Mailing Address - Fax:
Practice Address - Street 1:1902A LINCOLN BLVD # 108
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1315
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:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2305172M00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT291247Medicare PIN