Provider Demographics
NPI:1285755389
Name:JACOTT, ANN M (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:JACOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:KNOBLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7842 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3536
Mailing Address - Country:US
Mailing Address - Phone:312-485-1125
Mailing Address - Fax:
Practice Address - Street 1:7842 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3536
Practice Address - Country:US
Practice Address - Phone:312-485-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019683225100000X
AZ7622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1871647289Medicare NSC