1720027196 NPI number — KRISTIN DAHL JACOBY MS PT

Table of content: KRISTIN DAHL JACOBY MS PT (NPI 1720027196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720027196 NPI number — KRISTIN DAHL JACOBY MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBY
Provider First Name:
KRISTIN
Provider Middle Name:
DAHL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IRWIN
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720027196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 715868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19171-5868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-915-1910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7650 E PARHAM RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23294-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-282-6338
Provider Business Practice Location Address Fax Number:
804-285-3237
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305004909 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 192301 . This is a "ANTHEM PT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FOCUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 258462 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "COMPMANAGEMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CIGNA REHAB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008908761 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540885859 . This is a "C&O EMPLOYEE'S HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2485613 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CORVEL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 98999 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com