Active NPI
Jacob Thomas Dellinger, DPT
- Physical Therapist
- Macon, GA
National Provider Identifier
1053750141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT011005
- Practice address
- 3708 Northside Dr
Suite D
Macon, GA 31210-2404 - Phone
- (478) 745-4206
- NPI assigned
- Jun 21, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT011005 | GA | Primary |
Addresses
Primary practice location
3708 Northside Dr
Suite D
Macon, GA 31210-2404
Mailing address
3708 Northside Dr
Macon, GA 31210-2404
Phone (478) 745-4206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT011005 | Other | GA | STATE LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT011005 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425427200000",
"number": "1053750141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3708 NORTHSIDE DR",
"city": "MACON",
"state": "GA",
"postal_code": "312102404",
"telephone_number": "478-745-4206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3708 NORTHSIDE DR",
"address_2": "SUITE D",
"city": "MACON",
"state": "GA",
"postal_code": "312102404",
"telephone_number": "478-745-4206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLINGER",
"first_name": "JACOB",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-21",
"last_updated": "2015-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT011005",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE #",
"identifier": "PT011005",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.