Individual ProviderJacob ChackoPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address261 W Canford Park, Canton, MI 48187-6667(248) 935-3364PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Chacko does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1386822344Provider TypeIndividualFull NameChacko, JacobCredentialP.T.GenderMaleSole ProprietorNoEnumeration Date2/1/2008Last Updated2/1/2008Contact InformationPractice LocationPractice Address261 W Canford Park, Canton, MI 48187-6667Phone(248) 935-3364Fax(734) 983-0575Mailing LocationMailing Address261 W Canford Park, Canton, MI 48187-6667Phone(248) 935-3364Fax(734) 983-0575Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense5501009281Michigan