Provider Demographics
NPI:1538031026
Name:JACOBSEN, BRENT ALLEN (CMT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:JACOBSEN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3583 BEARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-4717
Mailing Address - Country:US
Mailing Address - Phone:937-952-8709
Mailing Address - Fax:
Practice Address - Street 1:2895 CHURN CREEK RD STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1158
Practice Address - Country:US
Practice Address - Phone:937-952-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist