Provider Demographics
NPI:1083599963
Name:TAYLOR, JACOB THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4584 SW 113TH AVE # 7-311
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7930
Mailing Address - Country:US
Mailing Address - Phone:567-242-3438
Mailing Address - Fax:
Practice Address - Street 1:12315 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1723
Practice Address - Country:US
Practice Address - Phone:954-435-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT43225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist