Provider Demographics
NPI:1285743849
Name:JACOBSEN, KARA JEAN (PT MLD/CDT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JEAN
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PT MLD/CDT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:JEAN
Other - Last Name:CENZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:36 CHICKERING DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-4419
Mailing Address - Country:US
Mailing Address - Phone:802-258-2337
Mailing Address - Fax:802-258-2307
Practice Address - Street 1:36 CHICKERING DR UNIT 106
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-4419
Practice Address - Country:US
Practice Address - Phone:802-258-2337
Practice Address - Fax:802-258-2307
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68357OtherBCBS
MA1294632OtherFALLON
MA0399132Medicaid
MA468310OtherTUFTS
MA0399132Medicaid