Individual provider Active NPI

Jacob Holt, PT, DPT, MS

  • Orthopedic Physical Therapist
  • Murray, UT
National Provider Identifier
1023791688
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
13395764-2401 Issued in UT
Practice address
5151 900 E #100
Murray, UT 84117
Phone
(801) 261-3321
NPI assigned
Aug 10, 2023
Last updated
Aug 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 13395764-2401 UT Primary

Addresses

Primary practice location

5151 900 E #100
Murray, UT 84117

Mailing address

213 W Civic Center Dr Apt 322
Sandy, UT 84070-1235
Phone (619) 246-3039

Other practice location 1

11762 S State St Ste 120
Draper, UT 84020-7158
Phone (801) 501-8359

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230926000717 UT Practitioner - Physical Therapist in Private Practice 9335593367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5151 S 900
Suite 100
Salt Lake City, UT 84117-6658
Phone (801) 261-3321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
13395764-2401UTMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hand & Orthopedic Rehabilitation Specialists CurrentSince Aug 14, 2023 Accepting new patients
Hand & Orthopedic Rehabilitation Specialists Current Accepting new patients
Hand & Orthopedic Rehabilitation Specialists CurrentSince Aug 14, 2023 Accepting new patients
Hand & Orthopedic Rehabilitation Specialists Past Accepting new patients

Locations

11762 S State St
Ste 120
Draper, UT 84020
Phone (801) 501-8359

5151 S 900 E
Ste 100
Murray, UT 84117
Phone (801) 261-3321

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1023791688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 W CIVIC CENTER DR APT 322",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840701235",
            "telephone_number": "619-246-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 900 E #100",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84117",
            "telephone_number": "801-261-3321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11762 S State St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840207158",
            "country_code": "US",
            "telephone_number": "801-501-8359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLT",
        "first_name": "JACOB",
        "credential": "PT, DPT, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "13395764-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.