Provider Demographics
NPI:1043619208
Name:JACOBS, MACKENZIE (DPT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COMMERCE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:119 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1728
Practice Address - Country:US
Practice Address - Phone:781-871-9500
Practice Address - Fax:781-871-9525
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist