Provider Demographics
NPI:1043854441
Name:COMSTOCK, JACOB W (PT, DPT, CERT DN)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 MAGISTERIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4105
Mailing Address - Country:US
Mailing Address - Phone:800-645-5678
Mailing Address - Fax:
Practice Address - Street 1:9368 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-231-3979
Practice Address - Fax:502-231-9891
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024810225100000X
IN05013763A225100000X
KYCP044823T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist