Provider Demographics
NPI:1447730080
Name:JACOBS, ROSA MARIE (PT)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 SENNA PL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2814
Mailing Address - Country:US
Mailing Address - Phone:281-980-8218
Mailing Address - Fax:
Practice Address - Street 1:3640 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3016
Practice Address - Country:US
Practice Address - Phone:281-778-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10293532251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics