Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2099 | SD |
N | 2251P0200X | Physical Therapist - Pediatrics | PT60176774 | WA |
NPI | 1053699769 |
---|---|
Provider Name | Amanda Christine Jacobsma |
First Address | Sioux Falls, SD 57105-5815 |
Second Address | Sioux Falls, SD 57105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 14/09/2018 |