Provider Demographics
NPI:1447685656
Name:JACOBSON, CHRISTINE U (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:U
Last Name:JACOBSON
Suffix:
Gender:F
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 1:141 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5557
Mailing Address - Country:US
Mailing Address - Phone:936-697-2511
Mailing Address - Fax:
Practice Address - Street 1:5695 KYLE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6305
Practice Address - Country:US
Practice Address - Phone:512-268-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist