Provider Demographics
NPI:1548159437
Name:JACOBSON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:JACOBSON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:847-525-5888
Mailing Address - Street 1:3672 AVENSONG VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7481
Mailing Address - Country:US
Mailing Address - Phone:470-305-3145
Mailing Address - Fax:
Practice Address - Street 1:3672 AVENSONG VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7481
Practice Address - Country:US
Practice Address - Phone:470-305-3145
Practice Address - Fax:470-706-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy