Provider Demographics
NPI:1972885754
Name:FLEMING, JACOB PIERCE (PT)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:PIERCE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25273
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0273
Mailing Address - Country:US
Mailing Address - Phone:864-608-8881
Mailing Address - Fax:
Practice Address - Street 1:27 BARNWOOD CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5486
Practice Address - Country:US
Practice Address - Phone:864-608-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21492251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics