Provider Demographics
NPI:1831929801
Name:ALLEN, JACOB (DPT)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S GAINES ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32759-9339
Mailing Address - Country:US
Mailing Address - Phone:321-505-2384
Mailing Address - Fax:
Practice Address - Street 1:1994 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8349
Practice Address - Country:US
Practice Address - Phone:386-516-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist