Provider Demographics
NPI:1285746628
Name:JACOBY, MELANIE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:JACOBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8638 VETERANS HWY
Mailing Address - Street 2:FL 1
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1422
Mailing Address - Country:US
Mailing Address - Phone:410-787-1874
Mailing Address - Fax:
Practice Address - Street 1:672 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1363
Practice Address - Country:US
Practice Address - Phone:410-729-0630
Practice Address - Fax:410-729-0091
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist