Provider Demographics
NPI:1053585828
Name:ANDERSON, JACOB EDWARD (MS, ATC, OTC, SA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS, ATC, OTC, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BEDFORD WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5526
Mailing Address - Country:US
Mailing Address - Phone:321-271-5548
Mailing Address - Fax:
Practice Address - Street 1:206 BEDFORD WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5526
Practice Address - Country:US
Practice Address - Phone:615-595-6436
Practice Address - Fax:615-261-2067
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant