Provider Demographics
NPI:1730895160
Name:BRODIE, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BRODIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HARLEY RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8238
Mailing Address - Country:US
Mailing Address - Phone:484-363-3836
Mailing Address - Fax:
Practice Address - Street 1:2167 KIMBERTON RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4758
Practice Address - Country:US
Practice Address - Phone:484-363-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist